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Letters of intent for medical school express your top choice school, indicating you will attend if accepted. Typically written after being wait-listed, these letters signal your strong interest. It's not appropriate to send a letter before an interview, as it may come off as disingenuous. Additionally, letters of intent should not be used as a strategy to improve your chances; they should be genuine commitments. Such letters can influence admissions decisions, aligning with the school's goal of filling seats with committed candidates.