Assistant Dean for Diversity and Inclusion
College of Medicine
Health Sciences Campus at Lake Nona
Greetings, Thank you for interest in the University of Central Florida College of Medicine Health Leaders Summer Academy 2015. The goal of the Health Leaders Summer Academy is to provide hands on education summer experiences for high school students who are interested in pursuing professional health related careers. The Academy will be from July 20th – 24th. Students will work with professors from the Burnett School of Biomedical sciences in various lab settings, conduct team research projects, and meet with representatives from various academic offices who will provide students information vital to their post‐secondary educational paths. There is no cost for the program and it will be held on UCF’s main campus with the final day held at the College of Medicine in Lake Nona. You are responsible for your own transportation to and from the program. Your application does not ensure admission to the program. Only those meeting academy criteria will be considered. Students will be notified by April 24th if they have been accepted into the academy. Please complete all forms attached to this letter and email to the address indicated on the application by April 3rd, 2015. Thank you and we look forward to seeing you at the academy! Sincerely, Lisa Barkley MD, FAAFP 6850 Lake Nona Blvd. • Orlando, FL 32827-7408 • 407-266-1021 • Fax: 407-266-1489
An Equal Opportunity and Affirmative Action Institution
Health Leaders Summer Academy 2015 Application July 20th – July 24th Requirements Applicants for the Health Leaders Summer Academy must meet the following criteria:  Must be a rising high school junior  Must have at least a 3.5 grade point average (on 4.0 scale)  Must have completed one year of Biology  Must be available to attend all required days of the academy  Must follow your school district’s code of conduct  Must include an unofficial copy of transcript along with application  Must have a positive outlook and be willing to learn Locations 
July 20th – 23rd ‐ University of Central Florida’s main campus 4000 Central Florida Blvd Orlando, FL 32816 
July 24th – UCF College of Medicine Health Sciences Campus at Lake Nona 6850 Lake Nona blvd. Orlando, FL 32827 All forms, including unofficial transcript, due by April 3rd, 2015. Please send completed applications to the address below: Nancy Charles Minority Achievement Office Ronald Blocker Educational Leadership Center 445 West Amelia Street Orlando, FL 32801 Please note: Application does not ensure admission. Space is limited. Students will be notified by April 24th, 2015 if they have been accepted into the academy. 1 Application Part I: To be filled out by the parents/student STUDENT First Name: _________________________ Last Name: ________________________ Address: _______________________________________________________________ City: _______________________________ State: ____________ Zip: _____________ Student Email: ___________________________ Student Cell: ______________________ Age: ____________ Gender: __________ Race/Ethnicity: _____________________ Current High School: _______________________ Do you receive free/reduced lunch? Yes No How will you get to and from Academy locations? _______________________________ Grade Point Average: Weighted _______ Un‐weighted _______ PARENT/GUARDIAN Mother/Guardian Name: _____________________________ Father/Guardian Name: ______________________________ Parent/Guardian Email: ______________________________ Parent/Guardian Cell: ________________________________ EMERGENCY CONTACT Name: _________________________________ Relationship to student: ___________________ Home phone: _______________ Cell phone: ______________ 2 PSAT Score: __________ In the space provided below, please write an essay describing your health career goals and aspirations. Your essay must be a minimum of 250 words. __________________________________________________________________________________________
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__________________________________________________________________________________________ __________________________________________________________________________________________ List any medical organizations you are member of and/or community service experiences you have had. I verify that the information included above is accurate. Student Initials: _______ Parent/Guardian Initials: _______ 3