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Mississippi Rural Physicians Scholarship Program
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MRPSP
Mississippi Rural Physicians Scholarship Program
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Main Content
MRPSP Scholarship Application
*
- Required fields
Priority Deadline: May 1, 2022
Personal Information
First Name
*
Last Name
*
Permanent Address
City, State, Zip Code
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
-
Cell Phone Number
*
(
)
-
Email Address
*
Date of Birth
Hometown
Place of Permanent Residency
Not a Permanent MS Resident
Counties:
Adams
Alcorn
Amite
Attala
Benton
Bolivar
Calhoun
Carroll
Chickasaw
Choctaw
Claiborne
Clarke
Clay
Coahoma
Copiah
Covington
DeSoto
Forrest
Franklin
George
Greene
Grenada
Hancock
Harrison
Hinds
Holmes
Humphreys
Issaquena
Itawamba
Jackson
Jasper
Jefferson
Jefferson Davis
Jones
Kemper
Lafayette
Lamar
Lauderdale
Lawrence
Leake
Lee
Leflore
Lincoln
Lowndes
Madison
Marion
Marshall
Monroe
Montgomery
Neshoba
Newton
Noxubee
Oktibbeha
Panola
Pearl River
Perry
Pike
Pontotoc
Prentiss
Quitman
Rankin
Scott
Sharkey
Simpson
Smith
Stone
Sunflower
Tallahatchie
Tate
Tippah
Tishomingo
Tunica
Union
Walthall
Warren
Washington
Wayne
Webster
Wilkinson
Winston
Yalobusha
Yazoo
Father's Name
Father's Address (street, city, state, zip code)
Father's Education
Mother's Name
Mother's Address (if different)
Mother's Education
Education
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)
Status
Applied
Accepted
Medical School Student ID# (if available)
Highest MCAT Sum
BCPM GPA
Overall GPA
How Will You Be Classified this Fall in Medical School?
M1
M2
M3
M4
Prioritize Your Preferences of These Six Primary Care Specialties (1= Highest and 6=Lowest)
Family Medicine
1
2
3
4
5
6
General Internal Medicine
1
2
3
4
5
6
Medicine-Pediatrics (Med-Peds)
1
2
3
4
5
6
OB/GYN
1
2
3
4
5
6
Pediatrics
1
2
3
4
5
6
Psychiatry
1
2
3
4
5
6
List Four Mississippi Towns of 15,000 or Fewer Residents Where You May Wish to Practice Rural Clinical Medicine in Order of Preference (1=Highest and 4=Lowest)
1.
2.
3.
4.
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:
I will practice one year for each year I receive the MS Rural Scholarship Program award in a pre-approved Mississippi rural or medically underserved community.
I am required to complete residency training in FAMILY MEDICINE, OB/GYN, GENERAL INTERNAL MEDICINE, PEDIATRICS, MEDPEDS, or PSYCHIATRY.
The Mississippi Rural Scholarship Program is given permission to contact any parties or to obtain any source of information necessary to verify my eligibility for this scholarship.
I am currently a permanent resident of the State of Mississippi.