A medical school letter of intent tells one school that you will attend if it admits you. The letter of intent medical school applicants send is short, but it carries a promise. Duke University’s prehealth advising office defines it as communicating “the applicant’s intention to attend the medical school if offered an acceptance”. It also says to send one “to only one school”.
Whether a school reads the letter at all is the school’s decision. On October 13, 2026, we read the admissions pages of five MD programs that state a policy. Three accept a letter of intent in some form and two do not, and each of the three sets its own timing.
Key Takeaways
- A letter of intent promises one school that you will enroll if admitted. Duke’s prehealth advisors say to send it to one school and not to change your mind if accepted.
- Pitt, Roseman and USF accept one in some form. Washington State and Utah do not consider or accept one (pages read October 13, 2026).
- Duke’s advisors say the letter generally follows an interview or a waitlist placement. USF’s page addresses it to waitlisted applicants.
- Duke’s office lists three things to say: why the school is your first choice, what you would bring, and that you will accept an offer.
- USF states that the letter does not raise the odds of acceptance or influence the decision.
What a Medical School Letter of Intent Says, and What It Does Not
Duke’s definition goes further than a wish to attend. Its office says the letter indicates “withdrawal from other schools which have already offered acceptance and withdrawal from waitlists”. The commitment holds after the offer too: send it to one school, and “if accepted, should not change your mind”.
Two other letters sit close to it, and Duke’s office keeps all three apart. An update letter reports something new and significant, such as published research, and makes no promise to enroll. A letter of interest, in Duke’s words, “communicates the applicant’s interest and belief that they are well-aligned with the medical school”.
Some schools count these letters together. Roseman University College of Medicine states: “Applicants may submit one Letter of Intent or one Update Letter per term after their application has been submitted.” At Roseman, a letter of intent uses the same allowance an update would.
Which Schools Accept a Letter of Intent? Medical School Policies Compared
Policies come from each school. Duke’s office says that “If and what types of communication a school accepts can be found in MSAR”, the AAMC’s Medical School Admission Requirements database. The table below sums up five schools’ own admissions pages.
| Medical school (page read October 13, 2026) | Letter of intent | What the page adds |
|---|---|---|
| University of Pittsburgh School of Medicine | Welcomes letters of intent/interest | One additional update or letter of interest allowed |
| Roseman University College of Medicine | Accepted | One Letter of Intent or one Update Letter per term |
| USF Health Morsani College of Medicine | Accepted from waitlisted applicants | From those certain they would enroll; the page says it does not affect the decision |
| WSU Elson S. Floyd College of Medicine | Not considered | No impact; not shared with the Admissions Committee |
| University of Utah Spencer Fox Eccles School of Medicine | Not accepted | Updates sent by letter of intent are not considered |
Pitt’s admissions FAQ says its committee “welcomes letters of intent/interest and updates to your application”. Its cap, “one (1) additional update or letter of interest”, does not say whether a letter of intent counts toward it. USF’s waitlist page accepts one if the applicant is “certain they will matriculate to USF MCOM if they are accepted off the waitlist”.
Two schools decline. Washington State’s Elson S. Floyd College of Medicine answers: “We do not consider letters of interest or intent at any point in our process.” Utah’s admissions FAQ is just as short: “The Office of Admissions does not accept letters of intent.”
So the five pages split three to two. None of the three that accept a letter says it improves an applicant’s chances, and USF’s says it does not. A school whose page says nothing has not said no; ask its admissions office.
When to Send a Letter of Intent
Duke’s office says these letters are generally sent “after an interview or being put on a waitlist”. The reason it gives is credibility: by then you should know the school well enough to have “strong credibility that you know this is the right school for you”. For any communication, its office also advises “waiting until mid to late October to send anything unless explicitly directed by a school to do something different”.
The school’s own rule comes first. Roseman takes one “after their application has been submitted”, and USF’s page speaks to applicants already on its waitlist. Our note: because the promise can go to only one school, the safest moment is the one when you can keep it.
How the Letter Fits AAMC's April 30 Protocols
The AAMC recommends a spring calendar for accepted MD applicants. Its applicant protocols, approved May 7, 2018, print their dates without a year. They say: “On or before April 30, choose the school or program to which you plan to matriculate and promptly withdraw your acceptances from all other schools or programs.” The same page places the 2027 AMCAS application at a fall 2027 start, so for that class the date falls in 2027.
AAMC’s Choose Your Medical School tool is where accepted applicants signal that choice. As read on October 13, 2026, the page says applicants holding an acceptance can select Plan to Enroll from Feb. 19, and Commit to Enroll becomes a second option from April 30. The tool does not replace the school: selecting Commit to Enroll “does not automatically withdraw applications from other medical schools”.
Our note: a letter of intent is not a substitute for either step, and at least one school acts on the tool directly: USF’s waitlist page warns that a Commit to Enroll selection elsewhere “will result in an automatic withdrawal from the USF Health MCOM”.
What to Say in a Medical School Letter of Intent
Duke’s office gives the content in one line: “explain why they are your first choice, what you would bring to that school and clearly state that you will accept an offer.” With the tips its office gives for any letter to a school, that makes five parts:
- Why this school is your first choice. Specific reasons, tied to the school.
- What you would bring to that school. One or two concrete contributions.
- A clear statement that you will accept an offer. A plain sentence that you will enroll, not a hope.
- Your details. Duke lists “name, cycle you are in, AAMC/TMDSAS/AACOMAS ID”.
- Thanks. “Be sure to thank the Admissions Committee for considering your application.”
On length, Duke’s office says “no more than a page long”. Our note: the reasons you gave in that school’s secondary essays are a fair starting point, as long as the letter adds what has changed since.
The admissions officers the AAMC interviewed for a waitlist article flag the habit to avoid: the form letter. Yvette Perry, PhD, associate dean at the University of Toledo College of Medicine and Life Sciences, describes top-choice emails where the candidate “has just dropped our institution’s name into a form email”. Judianne Kellaway, MD, of UT Health San Antonio’s Long School of Medicine, says such letters “should be honest and limited”.
Example Openings (Written by Us, Not Real Letters)
We wrote these two openings for this article to show structure. They are not any applicant’s letter, and the reasons in brackets have to be yours.
- Our example, after a waitlist notice: Dear Members of the Admissions Committee, my name is [Name], AAMC ID [number], and I am applying in the [2027 AMCAS] cycle. [School] is my first choice. If I am offered a place, I will accept it and withdraw from my other schools and waitlists.
- Our example, after an interview: Since my interview on [date], I have weighed where I want to train, and the answer is [School]. [One reason tied to what you saw that day, and what you would add to it.] If I am admitted, I will enroll.
What a Letter of Intent Can and Cannot Do
Three of the five pages say the letter will not change the outcome or will not be considered. USF says that “submitting a letter of intent will not increase the likelihood of being accepted nor influence an acceptance decision.” Washington State and Utah do not consider one at all.
Perry, speaking for Toledo in the AAMC article, puts it this way: “For our medical school, letters of intent rarely provide us with any certain, actionable information such that they would sway our admissions decisions.” She names one exception, new information that “sheds light on a candidate’s commitment to attend”.
Our note: on these pages the letter is not a second chance at the application, so put the effort into the application while you can still change it. If your primary and secondary applications are still in progress, ExceptionalGrad’s medical school application consulting page lists a Detailed Application Review, a review that “ensures that all sections of the application including essays and experiences are fully prepared for submission”.
Frequently Asked Questions
Is a medical school letter of intent binding?
It is a promise rather than the enrollment step. Duke’s prehealth advisors, in guidance read October 13, 2026, say that if accepted you “should not change your mind”. The final choice is separate: AAMC’s Choose Your Medical School tool offers Commit to Enroll, and AAMC says you must still tell each school directly.
Can you send a letter of intent to multiple medical schools?
No. Duke’s prehealth advising office says to send a letter of intent to only one school, and its definition treats the letter as withdrawal from other acceptances and waitlists. The AAMC’s waitlist article, read October 13, 2026, puts it practically: “don’t send letters to three schools telling each they are your top choice”.
Can you send a letter of intent before your interview?
Generally not, by Duke’s guidance read October 13, 2026. Its prehealth advisors say a letter of intent comes after an interview or a waitlist placement; the letter of interest is for applicants not yet invited to a secondary or an interview. A school’s own rule comes first, so check its page or MSAR profile.
How do you send a letter of intent to a medical school?
Each school names its own channel, as read October 13, 2026. Pitt asks for communications through its applicant portal once the application is complete. Roseman takes a waitlisted applicant’s letter as a PDF by email, and USF takes waitlisted applicants’ letters electronically at its admissions address. Duke’s advisors add: keep copies of everything you send.