In the US:
75-31 150
th
Street
Flushing, NY 11367
Phone: (718) 820-4919
FAX: 718-820-4838
Email: [email protected]
Web: lcm.touro.edu
In Israel:
11 Rechov Beit Hadfus
Givat Shaul, Jerusalem
Phone: (052) 346-6595
FAX: (02) 651-0097
Email: lavey.free[email protected]
HONORS PROGRAM APPLICATION
Please consider this application for (check the appropriate box(es):
The Lander College for Men Honors Program
The Medical Honors Pathway, in conjunction with New York Medical College, Valhalla, NY
Fall 2021 Deadline: March 1, 2021
Applicants: Complete the following application form and submit along with:
a) Two letters of recommendation. Each recommender must submit the Recommendation
Form (below) along with the recommendation letter. Medical Honors Pathway
Applicants: an additional letter of recommendation must be submitted from a medical
professional.
b) Two essays not exceeding 500 words (approximately 5,300 characters). See page 4 for
details. Medical Honors Pathway Applicants: An additional essay will need to be
submitted on: Why you are interested in a career in medicine and enrollment in the
Medical Honors Pathway.
Please note, the recommendation letters and samples of your written work are in addition to
those required for general college admission. Once a completed application is received, you
will be contacted for a personal interview.
1. Name (please use legal name):
Last
First
Middle
Preferred/ Hebrew
2. Email address: _________________________________@_______________________
3. Social Security # (optional): ____ - ____ - ____ 4. Touro ID # (If known): _T00_______
5. Telephone Number(s):
Home:
US Cell:
Israel Cell:
1
_____________
_____________
_____________
_____________
6. High School: _____________________
7. Post-High School Yeshiva (if currently attending): __________________________
8. Please indicate if you took or are planning to take the following standardized tests. Fill in
your scores where available. (Please be sure to have official copies of your scores sent to
Touro College)
A. SAT Exam:
Date:
Reading:
Math:
Writing:
B. ACT Exam
Date:
Composite Score:
English:
Math:
Science:
Writing:
C. Advanced Placement Exams
Date: ___________ Subject: ___________ Score:
Date: ___________ Subject: ___________ Score:
Date: ___________ Subject: ___________ Score:
Date: ___________ Subject: ___________ Score:
Date:
Reading:
Math:
Writing:
Date:
Composite Score:
English:
Math:
Science:
Writing:
2
D. SAT II Exams
Date: ___________ Subject: ___________ Score: _____________
Date: ___________ Subject: ___________ Score: _____________
9. Please provide the names and contact information for two referees (three for Medical
Honors Pathway Applicants) who can speak to your suitability for the Honors Program.
Each recommender must submit the Recommendation Form (below) along with the
recommendation letter. Medical Honors Pathway Applicants: one of the three letters of
recommendation must be from a medical professional.
1. Name:
Email:
2. Name:
Email:
For Medical Honors Pathway Applicants:
3. Name
Email:
10. What Awards and/or Honors have you received? (Please include dates or years, if known)
3
WRITING SAMPLES
Each applicant is expected to submit 2 original 500-750 word essays from among the
following topics; any sources you quote must be cited. Please note, if Hebrew phrases
or expressions are used, provide a translation in parentheses.
1. Briefly review the book that has most shaped your understanding of the kind of work
you would like to do.
2. Describe a character in fiction or a historical figure that has had an influence on you,
and explain that influence.
3. Has modern technology made it easier or harder to be an observant Jew?
4. How do your religious values affect your study of the past? Give examples.
Medical Honors Pathway –Addendum
The Medical Honors Pathway is an eight-year program (seven-years if one year was
spent in seminary/ yeshiva prior to undergraduate enrollment) that includes up to four
years of undergraduate study at one of the Lander College campuses in New York and
four years of medical school at New York Medical College, in Valhalla, NY, contingent
upon the completion of specific academic benchmarks. Please see the Medical Honors
Pathway brochure for further details.
Questions regarding the Medical Honors Pathway portion of the Honors application process
should be directed to:
Dr. Ann Shinnar
Lander College for Men
75-31 150
th
Street
Flushing, NY 11367
(718) 820- 4867
4
Medical Honors Pathway –Addendum Continued
A. What experience have you obtained so far with regard to the health sciences?
B. Applicants to the Medical Honors Pathway must provide documentation about his or her
clinical or research experience. If additional space is needed, feel free to add additional pages.
1-Experience
Name
Experience Type
(Research, Clinical
Volunteer, Non-
Clinical Volunteer,
Etc.)
Start And
End Dates
(Month/
Year)
Average
Hours Per
Week
During That
Period
Contact
Name And
Title
Organization
Name
Experience Description:
5
2-Experience
Name
Experience Type
(Research, Clinical
Volunteer, Non-
Clinical Volunteer,
Etc.)
Start And
End Dates
(Month/
Year)
Average
Hours Per
Week
During That
Period
Contact
Name And
Title
Organization
Name
Experience Description:
3-Experience
Name
Experience Type
(Research, Clinical
Volunteer, Non-
Clinical Volunteer,
Etc.)
Start And
End Dates
(Month/
Year)
Average
Hours Per
Week
During That
Period
Contact
Name And
Title
Organization
Name
Experience Description:
6
Upper 2%
Upper 10%
Upper 25%
Upper 50%
Lower 50%
No Basis
to judge
Intellectual Ability
Oral Expression
Written Expression
Motivation/Initiative
Cooperation
Emotional Maturity
Dependability
Creativity
Open Mindedness
Flexibility
APPLICANT’S LETTER OF REFERENCE
Student Section
(Please type or print)
Last Name:
First Name:
Middle Initial:
Hebrew/ Other Name:
Touro ID Number (if known):
I hereby waive my right of access to this recommendation.
I do not waive my right of access to this recommendation.
T00
Signature:
Date:
Respondent’s Section
(Please print or type)
Last Name:
First Name:
Title:
Signature:
Date:
Organization:
City, State, Zip:
To the Evaluator: The person named above has applied for admission to an Honors Program at a Lander College
Campus in New York, and has asked you to evaluate his/her ability to perform exceptional undergraduate work. If
the applicant has not waived the right to review this rating form, you should consider it non-confidential. Please
return the completed form in a sealed and signed envelope.
1. How long have you known the applicant and in what capacity? (Give dates, if possible.)
2. Rate the applicant in each area listed below in comparison with high school seniors.
3. (For teachers of applicant only) I would rank this applicant in:
the top _____ % of the approximately ______ high school or _______ undergraduate students that I have
taught in the past ______ years.
4. Estimate of potential (please circle the appropriate answer):
as an undergraduate student:
Outstanding
Good
Above
Average
Below Average
Average
as a professional:
Outstanding
Good
Above
Average
Below Average
Average
5. Recommendation concerning admission (check one):
I recommend the applicant with confidence.
I recommend the applicant with reservation. (Please explain in item #6)
I do not recommend the applicant. (Please explain in item #6)
6. Please provide an additional assessment of the applicant’s potential for success as an undergraduate student.
Include any particular strengths and weaknesses. We appreciate your candid appraisal. You may use your own
letterhead or this sheet.
Thank you!
