Mississippi Rural Dentists Scholarship Program

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MRDSP Scholarship Application


Priority Deadline: April 1, 2024

Personal Information
First Name* 
Last Name* 
Permanent Address
City, State, Zip Code -
Cell Phone Number*() -    
Email Address* 
Date of Birth 
Place of Permanent Residency
Father's Name
Father's Address (street, city, state, zip code)
Mother's Name
Mother's Address (if different)
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)
Dental School Student ID#
Highest DAT Sum
Overall GPA
How Will You Be Classified this Fall in Dental School?

Prioritize Your Preferences of These Types of Dentistry (1= Highest and 2=Lowest)
General Dentistry
Pediatric Dentistry
List Four Mississippi Towns of 10,000 or Fewer Residents Where You May Wish to Practice Rural Dentistry in Order of Preference (1=Highest and 4=Lowest)
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: