Virtual Pre-Medical Summer Scholars II Registration

Applicant's Information
INSTRUCTIONS TO COMPLETE APPLICATION: Type in your responses below.

Personal Data will remain confidential and will be used for reporting requirements set by program funding agencies.
Legal Name * Required
First Last
Have you applied to any medical schools before? * Required
- Yes
- No
If you are having difficulties with the application, please contact our Director of Outreach Programs: Kimberlyn Blann at blannkimberlynl@uams.edu or call our office during normal business hours at (501) 686-7299

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Contact Information
Address * Required
Street Address Address Line 2 City State ZIP Code
Personal Email * Required
College/University Email
Phone Number * Required
Emergency Contact Name * Required
First Last
Emergency Contact Phone * Required
Relationship to Applicant * Required
If you are having difficulties with the application, please contact Director of Outreach Programs: Kimberlyn Blann at blannkimberlynl@uams.edu or call our office during normal business hours at (501) 686-7299

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Applicant's Formative Years
For these next questions, please identify the community you lived in when you were (for example 1-5 years of age, 6-11, etc)
In what type(s) of communities were you primarily raised? (Check all that Apply) * Required
- Rural or Farming
- Inner City/Low Income
- Metropolitan (Densely Populated Area)
- Suburban (Outskirts of a city)
- Foreign Country
In what type(s) of housing situation(s) were you primarily raised? (Check all that Apply) * Required
- Homeless
- Public or Subsidized
- Rented by Family
- Owned by Family
If you are having difficulties with the application, please contact Director of Outreach Programs: Kimberlyn Blann at blannkimberlynl@uams.edu or call our office during normal business hours at (501) 686-7299

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MCAT
Have you taken the MCAT? (Check all that apply) * Required
- Taken "old" MCAT (2014 and older)
- Taken "new" MCAT (2015 and later)
- Have not taken MCAT
Old MCAT (2014 and older)
Old MCAT Test Date * Required
Old MCAT Score - TOTAL SCORE * Required
New MCAT (2015 and later)
New MCAT Test Date * Required
New MCAT Score - TOTAL SCORE * Required

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Supporting Documents Upload
Unofficial transcripts from all colleges and universities attended (PDF format). You can upload up to 10 files (total filesize max 50mb) * Required
Drop files here or

Accepted file types: pdf.
Personal Essay describing your personal, family and community background; your motivation for a medical career; what you have done to develop your interest and knowledge of modern medicine; and what you hope to accomplish by participation in the UAMS Division for Diversity Equity and Inclusion Summer Enrichment program (PDF or Word formats) * Required
Accepted file types: pdf, doc, dox.
Minimum of 1500 words, Maximum of 2000 words

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Letters of Recommendation
Reference #1
Reference #1 Name * Required
First Last
Reference #1 Title * Required
Reference #1 Company/Institution Name * Required
Reference #1 Email * Required

Upon submission of this application, an automated email will be sent to each of your reference at the address you provide here. The email will give your reference instructions for submitting a letter of recommendation.
Reference #2

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Application Submission
How did you hear about the UAMS PMSS program? * Required
- Undergraduate Program
- Pre-Health Advisor
- Friends/Peers
- UAMS DDEI Website
- Social Media
- AAMC
- ABRCMS
I declare that the applicant has provided correct information in this application form. I have checked and verified the application form and supporting documents. I hereby take full responsibility for any wrong verification made, or wrong documents submitted for the application. * Required
Type your FULL name in the space provided to digitally sign this application
Today's Date * Required

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Applicant's Information