7/30/2019 UT SHAPE Invitation and Information Packet Reply

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UT SHAPE

Interview Weekend, February 22 and 23, 2013

We look forward to welcoming you to UT Southwestern! Please take a few minutes to provide us with some

information as we prepare for your arrival. You may fax your responses to 214.648.3289 or email them to:

anne.mclane@utsouthwestern.edu . Call or email me if you have any questions or concerns. Please, share my

contact information with your family!

Thanks so much!

Anne

Anne P McLane

Associate Director of Admissions

214 648 5620 direct, 214 648 5617 main, 214 418 0208 mobile, Anne.mclane@utsouthwestern.edu

Your Name: _William Ip_____________________ Preferred First Name: ____William_____________________

Emergency Contact Name: _____Wai Kuen Chui___________________________________________________Emergency Contact Phone: ____6825540464________ Relationship to you: ___Mother___________________

Are you a vegetarian? __no____ Other dietary restrictions ____none_________________________________

The interview weekend:

Friday Clinical Rounds (Optional) -- The program begins at 8 a.m. on 2/22/13

Will you be attending the Friday Clinical Rounds program? __yes____

Note: You must complete the HIPAA 363 training module BEFORE arrival and bring a copy of my certificate with

you on Friday morning.

Friday Afternoon Program (Required) -- Your Friday Afternoon Program begins at 1 p.m.I will be bringing a guest(s) to the Friday Afternoon Program ______

-If you are bringing a guest (or guests)

-Guest 1 Name: __________________________ Vegetarian? _______ Other dietary restrictions ______ -

Guest 2 Name: __________________________ Vegetarian? _______ Other dietary restrictions ______

I will be attending the Friday Dinner with UT Southwestern Students _yes____

I will be bringing a guest(s) to the Friday Dinner

-If you are bringing a guest (or guests)

-Guest 1 Name: __________________________ Vegetarian? _______ Other dietary restrictions ______ -

Guest 2 Name: __________________________ Vegetarian? _______ Other dietary restrictions ______

Saturday Interview Sessions (Required) -- Your Saturday events begin at 8:30 a.m. 2/23/13

I will be bringing a guest(s) to the Saturday Program _____-If you are bringing a guest (or guests) _____

-Guest 1 Name: __________________________ Vegetarian? _______ Other dietary restrictions ______ -

Guest 2 Name: __________________________ Vegetarian? _______ Other dietary restrictions ______

I would like to stay with a UT Southwestern Student during my visit ____no______

Thursday night _____ Friday night _____

(We cannot accommodate your guests with student accommodations

7/30/2019 UT SHAPE Invitation and Information Packet Reply

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