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I have heard that when you send a letter of intent to a medical school and are accepted, it is often looked at as unethical to matriculate at a different school. I am currently alternate listed at SUNY Downstate and waitlisted at Stony Brook. Downstate is my top choice and I have sent them a LOI. Suppose I get off the waitlist at Stony Brook and accept my offer and then am accepted to Downstate a few days before orientation. Assuming I am all settled in for Stony Brook (i.e. all forms are in, I have an apt., etc), is it considered unethical to decline the Downstate acceptance? This is all hypothetical, but I was just wondering what you guys thought!