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Mississippi Rural Physicians Scholarship Program

MRPSP Scholarship Application

MRPSP Scholarship Application

May 26, 2017 Deadline

* = Required Fields

Personal Information

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

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
Medical School Student ID#
Highest MCAT Sum
BCPM GPA
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)
OB/GYN
Pediatrics
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)
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: