Transfer/Advance Standing Application

Transfer/Advance Standing Application
Please type in your information, print the form, and return it with the other required application materials to:

TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
OFFICE OF ADMISSIONS
8TH at RACE STREET
PHILADELPHIA, PA 19107

Call 1-800-220-FEET for questions.

Section One

Last Name First Name M.I.

Phone

Email

Social Security (last four digits only):

Present Mailing Address:
line 1
line 2
line 3

Permanent Mailing Address:
line 1
line 2
line 3

Telephone number (day):

Sex: Male Female

Date of Birth: month , date , year

Citizenship: USA Other (Specify Country)

If other, indicate: Permanent Resident F-1 Student Visa

Ethnic Background (Optional):
White Black Mexican Puerto Rican Other Hispanic Asian/Pacific Islander
Other

Previous Felony Conviction: Yes No

Previous Application to TUSPM through AACPMAS: Yes No
If yes, list year

Section Two:
Previous educational experience:
List all secondary and post-secondary institutions attended, starting with the most recent:

Institution
City
State
Degree
Years
Attended

Undergraduate Major: Minor:

List any honors or scholarships; books or articles published, etc.:

Medical College Admissions Test (MCAT):
Date: Verb Rea: Phys Sci: Writ: Bio:

Graduate Record Examination (GRE): Date Verb Quant Analy

Employment History:
List recent professional experience or attach a current resume.

Name and Location of Employer Dates of Employment Position/
Title

Section Three:
Essay. Please type your statement below (or attach to application), explaining: (1) your interest/experience in podiatric medicine, (2) your present situation, including why you wish to transfer to TUSPM, and (3) any additional information which you believe will help the admissions committee in their evaluation of your application.

I certify that the information in my application is accurate. I realize that my application cannot be reviewed until all requested credentials have been received by the Office of Admissions. I also understand that I must meet the prerequisite admissions criteria. If accepted, I agree to comply with the regulations of the college and to pay all fees required.

___________________________
SIGNATURE

_________________
DATE