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We promise not to sell or use your information for purposes not directly related to the VCU CERT program.  \nPersonal Information: Legal Name:  \nEmail:  \nPreferred Name: Phone Number:  \nStandardized Test Scores: Please only list MCAT, DAT, or GRE scores Date of Test:  \nScore Breakdown (e.g., Verbal, Quantitative, and Analytical Writing scores):  \nAdd additional comments about Test Scores here:  \nEducation:  \nList all baccalaureate or higher-level educational institutions attended (most recent first) .  \nName of Institution:  \nGraduation (or anticipated graduation) date:  \nCumulative GPA: Science GPA*:  \nName of Institution:  \nGraduation (or anticipated graduation) date:  \nCumulative GPA: Science GPA*:  \n*To calculate your science GPA accurately, please refer to the AAMC/AMCAS Course Classification Guidefor what constitutes a science course  \nCommunity Service  \nPlease approximate the number of unpaid volunteer hours you have in both clinical and non-clinical settings and list the time periods (i.e., start and stop month/year) when you completed these hours.  \nTitle, location, and Hours:  \nClinical Experience  \nApproximate the number of hours you have spent in clinical settings for which you earned pay or received academic credit. List your title (i.e shadowing, medical assisting, scribing) and hours completed, and please exclude hours completed prior to undergrad.  \nLocation(s) and Hours:  \nReturn to: CERT Program Coordinators  \n[premedcert@vcuhealth.org](premedcert@vcuhealth.org)  \nCERT Quick Look – Self-Reporting for  \nProspective Applicants  \nRequired Prerequisite Didactic Coursework:  \nFill in the course information below. If you repeated any courses, please include all grades earned.  \n\n| Prerequisite Course | Course Name and Number | Letter Grade\u003Cbr>Earned | Lab Included? |\n| --- | --- | --- | --- |\n| Biology I |  |  | Y N |\n| Biology II |  |  | Y N |\n| Chemistry I |  |  | Y N |\n| Chemistry II |  |  | Y N |\n| Organic Chemistry I |  |  | Y N |\n| Organic Chemistry II |  |  | Y N |\n| Physics I |  |  | Y N |\n| Physics II |  |  | Y N |\n| Mathematics I |  |  | Y N |\n| Mathematics II |  |  | Y N |\n|  |  |  | Y N |\n|  |  |  | Y N |\n\nUpper-level Science Coursework:  \nPlease list additional upper-level undergraduate or graduate science courses you have completed and enter the grade(s) earned. Common upper-level science courses include, but are not limited to: Immunology, Genetics, Biochemistry, Microbiology, Neuroscience, and Pharmacology.  \n\n| Course | Course Name and Number | Letter Grade\u003Cbr>Earned | Lab? |\n| --- | --- | --- | --- |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n\nPreferred Matriculation Date  \nPlease put a ‘✓’ next to your choice.  \nFall 2025 Spring 2026 Fall 2026 Spring 2027 Fall 2027 Spring 2028  \nReturn to: CERT Program Coordinators  \n[premedcert@vcuhealth.org](premedcert@vcuhealth.org)  \nCERT Quick Look – Self-Reporting for  \nProspective Applicants  \nPersonal statement (approx. one page)  \nIn 5300 characters or less, briefly describe your professional school/career goals, impactful experiences, and preparation for admission to professional school. Be sure to state your individual reason(s) and motivation for pursuing a health care career/professional school.  \nReturn to: CERT Program Coordinators  \n[premedcert@vcuhealth.org](premedcert@vcuhealth.org)","cbCailFygRdBbYOQ","https://ap.wps.com/l/cbCailFygRdBbYOQ","pdf",1035845,"English","# Self-Reporting Sections\n## Personal Information and Test Scores\n## Education and Community Service\n## Clinical Experience\n## Required Coursework and Upper-Level Science\n## Preferred Matriculation Date\n## Personal Statement","[{\"question\":\"What standardized test scores are applicants asked to report?\",\"answer\":\"Applicants are instructed to list only MCAT, DAT, or GRE scores, including the date of test and a score breakdown (Verbal, Quantitative, and Analytical Writing).\"},{\"question\":\"How is science GPA related to the application form?\",\"answer\":\"The form requests both cumulative GPA and science GPA, and it directs applicants to the AAMC/AMCAS Course Classification Guide to calculate science GPA accurately.\"},{\"question\":\"What is included in the personal statement and what is the length limit?\",\"answer\":\"Applicants must write a personal statement (approximately one page) in 5300 characters or less, describing professional school/career goals, impactful experiences, and motivation for pursuing a health care career or professional school.\"}]","CERT Quick Look - Self-Reporting for Prospective Applicants | PDF"]