MCAT Prep Course APPLICATION Please print or type

Requirements:

2.75 cumulative GPA Current cumulative college transcript – not official Interest in attending medical school $450 Tuition Fee Preferred: Juniors & Seniors who have completed

prerequisite courses for medical school Application Deadline – March 7, 2018 (seating limited)

Name_______________________________________________________________________________________

Last First Middle Initial

Current Address______________________________________________________________________________ Number/Street or PO Box City State Zip Code

Hometown Address____________________________________________________________________________ (Where you grew up) Number/Street or PO Box City State Zip Code

Cell phone number _____________________ Other___________

Email address(es) ____________________________________________________

Date of Birth_______/______/_______ Gender: _____Male _____Female

Month Day Year

Ethnicity: _____Black/African American _____White _____Asian _____American Indian _____Hispanic _____Am. Indian _____Alaskan Native _____Other Check the courses you have taken or are presently enrolled in: ______Biology ______Chemistry 1 ______Physics 1 ______Organic Chemistry 1 ____ Biochemistry ______Biology ______Chemistry 2 ______Physics 2 ______Organic Chemistry 2 ____ Genetics

List other science courses you have taken other than the science requirements listed above. __________________________________________________________________________________________ __________________________________________________________________________________________ In what college are you enrolled? _____________________________Major?____________________________ What is your current cumulative GPA? _________________________ ACT score? _______________________

Describe your health career goals and interests at this time, including when you intend to apply to medical school. (i.e. I’m interested in going into family medicine. I will apply to UAMS in the fall of 2019)

__________________________________________________________________________________________

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Dates: May 14th - June 8th, 2018 Monday - Friday Time: 9:00 AM – 4:00 PM Lunch Provided Location: Arkansas State University

Questions? Contact Dr. Ron Johnson – Professor of Genetics, ASU. RLJ@astate.edu Yalanda Merrell – Recruiting Specialist/Advisor UAMS Northeast 870-834-5067; yyoung@uams.edu

Submit completed application, check, and transcript (can be unofficial) to Yalanda Merrell UAMS Northeast 311 East Matthews Jonesboro, AR 72401