INITIAL SCREENING APPLICATION
Thank you for your interest in our potential medical school competition series for a major broadcast television network.
To apply, please fill out the Initial Screening Application below. Please do your best to complete all of the questions below as thoroughly as possible.
YOU MUST BE 15 OR OLDER AND A LEGAL U.S. RESIDENT TO BE CONSIDERED. IF THE APPLICANT IS A MINOR, THIS APPLICATION MUST BE COMPLETED AND SUBMITTED BY THE APPLICANT’S PARENT OR LEGAL GUARDIAN ON HIS/HER BEHALF, AND THE PARENT/LEGAL GUARDIAN MUST ANSWER ALL OF THE QUESTIONS BELOW.
SEE BELOW FOR FULL ELIGIBILITY REQUIREMENTS
All questions containing an asterisk (*) MUST be answered.
Terms, conditions and eligibility requirements apply.
First Name *
Last Name *
Phone Number: *
Relationship Status: *
Do you have children? If so, please list ages and names:
What is your current occupation and title? *
Are you currently attending school? If so, what school and where?
How did you hear about this casting? *
Tell us a little bit about yourself. Describe your personality. How would your friends describe you?
Tell us about your upbringing?
What is your most important relationship? Who is the most influential person in your life?
What is something that someone would be surprised to learn about you?
Describe a challenge you have had to overcome?
Do you have any interesting hobbies, interests or special talents outside your studies/medical industry?
Are you a competitive person? Why or why not? Please explain.
How do you work under pressure and deadlines?
How do you react to criticism?
Why do you want to be a doctor?
In what form of medical practice would you like to specialize?
Do any members of your family work in the medical field? If so, please explain.
What are your long term goals in the medical field?
What is your highest level of education? Please list any and all earned degrees: *
Which of the following medical school pre-requisite courses have you completed?
If you have already graduated, what have you done since earning your undergrad degree?
What is/was your overall undergraduate GPA?
Did you take the Medical College Admission Test (MCAT)? If so, when did you complete the test and what is your score? If not, when do you plan on taking the test?
Please list any medical accreditations, achievements, and distinctions.
What are your preferred medical school(s) you would like to attend and why?
Why are you applying for the show? What would this opportunity mean to you?
APPLICANT INTRO VIDEO: Please introduce yourself and explain why you would like to be considered for this opportunity in three (3) minutes or less.
Please upload a clear and recent photo of yourself: *
Please upload a second recent photo of yourself: *
Please list all television and digital media (e.g., Netflix, Amazon, Hulu) appearances (talk shows, televised talent competitions, reality shows, etc.) and what your role was. If none to mention, then write "N/A". *
Please list all non-television recordings or broadcasts you have been involved with (including, but not limited to, radio, film, record, podcast, etc.). If none to mention, then write "N/A". *
Are you currently being considered for any shows? If so, which ones? If not, write "N/A". *
Have you ever served in the military? *
If you marked YES, please list the following: BRANCH OF MILITARY YOU SERVED IN, DATE OF SERVICES AND TYPE OF DISCHARGE.
Have you ever been convicted of a felony or a misdemeanor? *
If YES, please give dates and details.
Have you ever been a party to a civil lawsuit? *
If YES, please describe when and where the event occurred, the other party(ies) to the lawsuit, whether you were the plaintiff or defendant, the nature of the case, and what the outcome was:
Have you ever had a temporary restraining order issued against you or has anyone ever attempted to obtain a temporary restraining order against you? *
If YES, please give details, including, without limitation, date(s), place(s), name of party seeking the temporary restraining order and relationship of such party to you, and a description of the basis upon which the temporary restraining order was sought, whether it was issued, and the basis upon which it was issued.
Have you ever done or been involved in anything that may negatively affect the Program, the Producer, the network broadcasting the Program or anyone else participating in or affiliated with this Program? *
If YES, please list and explain the specific matters:
ELIGIBILITY REQUIREMENTS AND RELEASES:
PLEASE READ AND ACCEPT THE FOLLOWING *
PLEASE READ AND ACCEPT THE FOLLOWING: *
BY SUBMITTING THIS COMPLETED INITIAL SCREENING APPLICATION FOR A POTENTIAL TELEVISION SERIES YOU CONFIRM THAT:
(i) YOU HAVE ANSWERED ALL THE QUESTIONS IN THIS INITIAL SCREENING APPLICATION HONESTLY AND TRUTHFULLY; AND
(ii) YOU HAVE READ, UNDERSTOOD, AND AGREE TO THE TERMS AND CONDITIONS CONTAINED HEREIN.
Please provide your date of birth: *
If the applicant is under 18 years of age, his/her parent or guardian must sign below and in doing so, he/she represents that he/she is your parent/guardian, confirms all of the information he/she has listed in this initial screening application and consents to your potential participation in the proposed television series.