MHD SROP Online Application

You do have to complete the application in one sitting, so please have all information ready before you start the application. Your application will not be saved until you press submit at the end of the application.

If you have any technical problems with the application, please contact the Graduate College Webmaster

Personal Information

First Name: *

Middle Name:

Last Name: *

Suffix:

Email address: *

Other Names on Transcripts:

Gender: *

Male

Female

Date of Birth: *

What is your legal status in the United States?: *

(Upon acceptance to the program, you will be required to supply your Social Security number or your Alien Residence number.)

Eligibility

Review the official Eligibility Requirements

Please choose the option that shows how you are eligible for this program: *

If you are American Indian/Alaska Native, please indicate your tribal affiliation:

If you are Native Hawaiian or Other Pacific Islander, please indicate which island you are from:

Contact Information

Home Telephone Number: *

Cell Phone Number: *

Permanent Telephone Number (phone for future contact, e.g. parents): *

Current Mailing Address

Address Line 1: *

Address Line 2:

City:

State/Province: *

Country: *

Zip Code: *

Permanent Mailing Address (address for future contact e.g. parents)

Address Line 1: *

Address Line 2:

City: *

State/Province: *

Country: *

Zip Code: *

Education

School Attending: *

If not currently, have you been a UA Student?: *

If yes, when?:

Major: *

Minor: *

GPA: *

Number of units completed: *

Semester or Quarter Hours?: *

Year in School: *

Expected Graduation Date: *

Courses you are taking this fall/spring that do not appear on your transcript: *

Career Goals

Do you plan to take the Graduate Record Examination (GRE)?: *

If yes, when?:

Do you plan to take the Medical College Admission Test (MCAT)?: *

If yes, when?:

First preference for post-baccalaureate degree : *

Second preference for post-baccalaureate degree:

Third preference for post-baccalaureate degree:

If you chose other, please explain:

If applying to graduate school, to which universities do you plan to apply?: *

What is your field of interest for graduate study?: *

Personal Statement

Describe the area in which you would like to conduct research if selected for this program. Be as specific as possible about research projects of particular interest to you. Be sure to include what you hope to accomplish through participation in this program and your academic career goals.

We suggest that you write your personal statement using a word processor (for example Microsoft Word) and then copy and paste it into the following text area.

Personal Statement: *

In order to match participants with appropriate faculty mentors, please choose three research areas in which you are interested.

First Choice: *

Second Choice:

Third Choice:

Letters of Recommendation

Please submit one letter of recommendation from a faculty member at your school along with an MHD SROP Reference Form. The form and letter of recommendation should be submitted to us directly by the faculty mentor to: MHD SROP, Graduate College Diversity Programs, The University of Arizona, 1031 N. Mountain Ave., Tucson, AZ 85721-0102 OR a signed PDF letter of recommendation maybe emailed to Stephanie Adamson.

Reference

Name: *

Title: *

University: *

Email Address: *

Research Mentor

If you have had prior research experience, please list the research mentor as a reference.

Name:

Title:

University:

Email Address:

Research and Training Experience

Briefly describe any prior extracurricular and community activities and research and/or work experience you have had in a university setting or elsewhere

Extracurricular or Community Activities. Please include the type of Activity, Offices Held/Major Contribution, & Hours per Week:

Research and/or Work Experience. Please include the Name of Employer, Location, Type of Work and starting and ending Dates.: *

Have you participated in the following programs?

MARC (U*star): *

MBRS (SCORE, RISE, IMSD): *

Bridges: *

PREP: *

McNair: *

TRIO: *

SLOAN: *

Other Program: *

If you selected “Other Program” please state which one:

Honors, Awards or Recognition. Please include the Honor or Award Title, the Awarding Agency and the Date each was received: *

How did you hear of the MHD Summer Program?: *

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MHD SROP Online Application