Pre-Medical Committee And

WESTMONT COLLEGE

Pre-Medical Committee and

Composite Letter of Evaluation

This form is to declare the members of your pre-medical committee, and to provide for the medical schools a composite recommendation summarizing the evaluations of each of the members. Please fill in the names and departments of the instructors you have chosen in the space below (needs to be typed), recognizing that you should have at least four additional members, and usually not more than six individuals listed. Also, two of these members should be from the Biology, Chemistry, Mathematics, or Physics Departments (additional members may be chosen from these departments if desired). One member should be from outside of the sciences and mathematics. An additional non-academic letter from a physician or health professions supervisor is strongly encouraged.

Note that as the pre-medical advisor, Dr.Cantrell serves ex officio as the chair of the committee.

I do hereby waive any rights of access that I may possess under any federal or state law to any letter of evaluation that is supplied by any of the faculty or staff of Westmont College, and is contained in my student records as maintained by either Westmont College or any other institution to which such a letter may be sent at my request.

Applicant ______

Signature Date

Committee Member Departmental Affiliation (& college if not Westmont)

Kristi CantrellChemistry - Chair of Committee