Program Phases

Rural Physicians Scholarship Program Home
  • MRPSP Scholarship Application

    April 1, 2015 Deadline

    * = Required Fields

    Personal Information

    First Name*
    Last Name*
    Permanent Address
    City, State, Zip Code -
    Cell Phone Number*()--
    Email Address*
    Date of Birth
    Place of Permanent Residency
    Father's Name
    Father's Address (street, city, state, zip code)
    Mother's Name
    Mother's Address (if different)


    High School Name, Town, and Year of Graduation
    Highest Composite ACT Score
    List Colleges Attended, Date of Attendance, and Degree Earned
    School of Medicine to Which You've Been Accepted or Are Attending
    Admission to Class Year Entering In (Year)
    Medical School Student ID#
    Highest MCAT Sum
    Overall GPA
    How Will You Be Classified this Fall in Medical School?

    Prioritize Your Preferences of These Five Primary Care Specialties (1= Highest and 5=Lowest)
    Family Medicine
    General Internal Medicine
    Medicine-Pediatrics (Med-Peds)
    List Four Mississippi Towns of 20,000 or Fewer Residents Where You May Wish to Practice Rural Clinical Medicine in Order of Preference (1=Highest and 4=Lowest)

    Personal Insights

    Please Provide Brief Responses to the Following Questions:
    1. What Motivates You to Choose a Rural Lifestyle and Medical Practice Location?
    2. Describe the Pivotal Moment in Your Life When Rural Medicine Became Your Primary Professional Goal.
    3. Identify the Most Influential Person in Your Decision to Become a Rural Physician and Why.
    4. What is Your Most Significant Personal Strength?
    5. Of What Personal Accomplishment Are You Most Proud and Why?
    6. Identify Your Most Significant Weakness.
    7. Describe Your Greatest Academic Challenge to Date.
    8. What Aspect of Medical School Are You Most Apprehensive Of?
    Place a check by each statement below to indicate your understanding and willingness to comply: