Mississippi Rural Physicians Scholarship Program

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MRPSP Scholarship Application

* - Required fields

Priority Deadline: May 1

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)
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
Medical School Student ID# (if available)
Highest MCAT Sum
BCPM GPA
Overall GPA
How Will You Be Classified this Fall in Medical School?
Prioritize Your Preferences of These Six Primary Care Specialties (1= Highest and 6=Lowest)
Family Medicine
General Internal Medicine
Medicine-Pediatrics (Med-Peds)
OB-GYN
Pediatrics
Psychiatry
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: