Secondary application form

Fall 2013 entering class

Admissions Ofce Toll free 1-800-345-1560
102 Grosvenor Hall
1 Ohio University
Athens, Ohio 45701
To the applicant
Completion of this form is mandatory for consideration of your application.
Please print legibly or computer generate your response and return with a check or money order in amount of
$60.00 payable to Ohio University.
Personal information
Attached you will nd a secondary application form and an optional, condential Pre-Professional
Evaluation form. Out-of-state applicants will also nd a Contract of Admission and an Out-of-State
Scholars Information Sheet.
Name ______________________________________________________________________________________
Last First Middle
Social Security number ________________________________________________________________________
Current mailing address _______________________________________________________________________
Street number
___________________________________________________________________________________________
City State/Zip
Telephone number _________________________________ Cell number _____________________________
Area code Number Area code Number
E-mail address _______________________________________________________________________________
Days and times you can be reached _____________________________________________________________
Are you a U.S. citizen? _______ or on a permanent VISA? _______ or other? _______
If other, please dene _________________________________________________________________________
Are you a legal resident of the state of Ohio? YES _________ NO _________

Do you plan on applying to the D.O./Ph.D. program? YES _________ NO _________
(Mark YES only if you plan to apply to the D.O./Ph.D. program)
The Heritage College of Osteopathic Medicine at Ohio University is interested in nding out more about
you as an applicant. To enable us to gain a better understanding of your activities, working experiences, and
personal philosophy and their relationship to osteopathic medicine, you are asked to complete this secondary
application form. Please be open, candid and honest in your responses. Feel free to draw on your school
experiences, extra-curricular activities, or working experience as a basis for your answers.
(over)
Mahmood
Madiha
770-40-9121
1420 Bella Coola Dr.
Orlando
FL- 32828
407-482-1067 407-408-4587
madiha.mahmood06@gmail.com
X
X
X
Evening 3-8 p.m.
We prefer you limit your personal statement to the space provided. If additional space is absolutely necessary, please use a
sheet of 8 1/2 X 11 plain paper, and put your name in the upper right corner.
Personal statement
In the space provided below, indicate: why you wish to become an osteopathic physician; why you wish to attend the
Ohio University Heritage College of Osteopathic Medicine; and any additional information you feel the college should
know about you.
Please type or computer generate your personal statement.
Name ________________________________________________________________________________________________
Last First Middle

I certify that all responses in the Personal Statement are my own and true. For the purpose of determining admission,
I hereby consent to and authorize any educational institution which I have previously attended to release academic
and/or disciplinary information to the Ohio University Heritage College of Osteopathic Medicine. I understand that
falsication of information by any means, including omissions, will result in immediate rejection of my application or
revocation of an offer of admission.
_____________________________________________________________________________________________
Signature of applicant Date
Mahmood
Madiha
9/3/2012
My wish to become an osteopathic physician is due to my experience shadowing an osteopathic
physician and a Medical Doctor I found out that osteopathic doctor have a better understanding of
the body, because they see the patient as a whole and not just focus on the one problem. Such as I
saw one patient come in with a complain of pain in the arms, and one doctor told her that she has
carpal tunnel syndrome, but it turned out to be that her third rib was misaligned. When the DO did
manipulation on the patient, she left feeling much better. I saw a patient who is 110 years old and
coming to Doctor of osteopathic who practices the manipulation for about ten years and was saying
that the treatment is what has made her live a pretty long life, when an average age of a person is 78
in USA.
I wish to attend Ohio University Heritage College of Osteopathic Medicine because it would give be
opportunity to learn and have skill of a successful Doctor of Osteopathic, by the special programs it
offers, I am really interested in the two programs Osteopathic Manipulative Medicine and
International Medicine Program, and instructors and prospects the University provides. I believe that
having an opportunity to have these experience and skill; will make me a better physician. Due to
my experience in a third world country health care system I believe understanding the body and
learning the osteopathic Manipulation is really important, because there is shortage of medicine, so a
doctor cannot really rely on medicine to do the job. I believe knowing how to help a person other
that drugs, having an extra skills such Osteopathic manipulation treatment can make me help my
patient with more than one way.