APPLY HERE: MCAT Prep Scholarship Application

Name *

First

Last

Permanent Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Date of Birth *//

Gender *

If you prefer to self-describe your race, please do so here

Residency Status *

If you chose other, please provide a description here.

Race / Origin *

If you prefer to self-describe your race, please do so here

Are you a veteran or currently serving in the United States Armed Forces? *

Education

This application is for a student currently identifying as: *

College Junior
College Senior
College graduate
Non-traditional students* (*includes individuals that have graduated from college more than 5 years ago)

What is/was your undergraduate major? *

Please list your undergraduate GPA: *

*If you do not believe your GPA accurately reflects your scholastic capability and achievement, please provide a brief explanation for the discrepancy.*

Expected Graduation Date (or prior graduation date) *

Undergraduate Institution Name *

Undergraduate Institution Address *

Address Line 1

Address Line 2

City

State

Zip Code

If you pursued an advanced degree (Master's degree, PhD, DMD, etc), What is/was your planned major?

Please list your advanced degree GPA:

Expected Graduation Date (or prior graduation date) *

Graduate Institution Name

Graduation Institution Address

Address Line 1

Address Line 2

City

State

Zip Code

Provide a brief description and explanation (1-2 Paragraphs) of the community activities in which you are involved. *

Provide a brief description and explanation (1-2 Paragraphs) of your most meaningful leadership experience. *

Describe any additional circumstances that you believe our review committee should take into consideration.

Recommendation

If you would like to have an individual recommend you, please submit their information below. This is not required but it is highly recommended.

Name

First

Last

Relationship

Email Address

Phone

Essay: One to three-page double-spaced essay (11- 12 pt. font, Arial/Times New Roman) outlining your career goals and where you see your career path leading you. You can include accomplishments relevant to increasing awareness about diversity in your community. *