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Mississippi Rural Dentists Scholarship Program
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MRDSP
Mississippi Rural Dentists Scholarship Program
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Mississippi Rural Physicians Scholarship Program Home
Main Content
MRDSP Scholarship Application
April 15, 2020 Deadline
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)
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 Dentistry to Which You've Been Accepted or Are Attending
Admission to Class Year Entering In (Year)
Status
Applied
Accepted
Dental School Student ID#
Highest DAT Sum
BCPM GPA
Overall GPA
How Will You Be Classified this Fall in Medical School?
D1
D2
D3
D4
Prioritize Your Preferences of These Types of Dentistry (1= Highest and 2=Lowest)
General Dentistry
1
2
3
4
5
Pediatric Dentistry
1
2
3
4
5
List Four Mississippi Towns of 20,000 or Fewer Residents Where You May Wish to Practice Rural Dentistry 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 Dental Practice Location?
2. Describe the Pivotal Moment in Your Life When Rural Dentistry Became Your Primary Professional Goal.
3. Identify the Most Influential Person in Your Decision to Become a Rural Dentist 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 Dental 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 Dentists Scholarship Program award in a pre-approved Mississippi rural or medically underserved community.
The Mississippi Rural Dentists 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.