**PERSONAL INFORMATION**
Last/Family Name
* must provide value
First name
* must provide value
Other name on official/academic records (i.e. maiden name, nickname)
Date of Birth
* must provide value
(MM/DD/YYYY)
Place of birth
* must provide value
(City, State, Country)
Date you earned or expect to earn your Bachelor's degree (Individuals who earned their Bachelor's degree before June 1, 2021 are not eligible for this program).
mm/yyyy
The purpose of PREP is to increase diversity within the field of the biomedical sciences, including supporting students from underrepresented and/or disadvantaged groups in the biomedical sciences. The list of criteria for eligibility can be found on the NIH website:
https://grants.nih.gov/grants/guide/notice-files/NOT-OD-20-031.html
Please write one to two paragraphs that describe how your background aligns with the goals of PREP:
Are you of Hispanic or Latino origin?
* must provide value
Racial self-description
* must provide value
**CITIZENSHIP & RESIDENCY**
Country of Citizenship:
IMPORTANT!! Only U.S. citizens and permanent residents are eligible for the PREP Program.
* must provide value
i.e. USA
**NON-US CITIZENS**
Are you currently recognized as a Permanent Resident Alien of the United States?
* must provide value
Yes
No
If yes, please submit a copy of both front and back of your current Resident Alien ID card.
If you have difficulty uploading your document, please email it directly to elwoodb@musc.edu.
Have you previously applied to the Medical University of South Carolina (MUSC)? If yes, to which college or program?
We may be able to use application materials already submitted, for example letters of recommendation and transcripts.
If you have applied previously to MUSC, when did you apply?
Have you previously applied to any PhD programs?
Yes
No
Email Address
IMPORTANT! You must provide us with a valid email address to complete your application. We will use this email address as our primary means of communicating with you regarding updates about your application status. Please configure any junk-email filters to allow emails from @musc.edu. NOTIFY US (elwoodb@musc.edu) immediately if your email address changes so that you won't miss important notices.
* must provide value
xxxxxx@xxxxxxx.xxx
Primary Phone Number (the number we should try first)
* must provide value
(xxx) xxx-xxxx
(xxx) xxx-xxxx
Preferred Mailing Address:
(The address you want mail to go to throughout the application process, through May 1, 2023. Please let us know as soon as this address changes.)
* must provide value
street, apt#, city, state, zip code, country
Permanent mailing address:
Leave this blank if the same as above.
(Someone here will always know how to reach you)
street, apt#, city, state, zip code, country
How did you FIRST learn about MUSC PREP?
**EDUCATION**
List in chronological order ALL colleges and/or universities attended, including MUSC and USC
(School #1). Include school name, city and state, and years attended.
* must provide value
college, city, state, dates of attendance (mm/yyyy to mm/yyyy)
School #1: List Major, degree obtained if any
* must provide value
Major, degree obtained if any
college, city, state, dates of attendance (mm/yyyy to mm/yyyy)
School #2: List Major, degree obtained if any
Major, degree obtained if any
college, city, state, dates of attendance (mm/yyyy to mm/yyyy)
School #3: List Major, degree obtained if any
Major, degree obtained if any
Transcripts (Please combine all transcripts from all schools into 1 pdf document).
**Unofficial transcripts will be accepted, but official transcripts will be needed before final enrollment into MUSC PREP.
If you have difficulty uploading your document, please email it directly to elwoodb@musc.edu.
* must provide value
If everything goes well, what career do you hope to have in 10 years?
* must provide value
College Professor, teaching and doing research College Professor, mostly teaching Health care provider: physician, dentist, pharmacist, veterinarian, nurse, psychologist Scientist working in industry Science policy maker/ advisor Other (Please explain in your statement of interest)
**TEST SCORES**
Please check any test you have previously taken.
If you are registered to take one of these exams, but don't have a score yet, please list test type, and test date.
test, date, score
Optional: Upload unofficial score report for any standardized exams you wish to be considered
If you have difficulty uploading your document, please email it directly to elwoodb@musc.edu.
**REFERENCES**
Please provide the names, occupations, and email address for 3 references.
College professors and research supervisors are preferred, but not required. PLEASE DO NOT SOLICIT LETTERS! We will contact your references for their recommendations after the rest of the application is reviewed for eligibility and fit for our program.
REFERENCE #1 Name
* must provide value
Last Name, first name
Research Mentor
Professor, class instructor
other
Occupation
employer
email address, Reference #1
* must provide value
email address
REFERENCE #2 Name
* must provide value
Last Name, First name
Research Mentor
Professor, class instructor
other
Occupation,
employer
email address, Reference #2
* must provide value
email address
REFERENCE #3 Name
* must provide value
Last Name, First name
Research Mentor
Professor, class instructor
other
Occupation
Employer
email address, Reference #3
* must provide value
email address
**REPORT OF CRIMINAL CHARGES**
The University is required by law to perform criminal background checks on employees.
Have you ever been convicted of a felony or misdemeanor? (Exclude minor traffic violations such as speeding tickets.)
* must provide value
Yes
No
Are you now under charges for any offense against the law? (Exclude minor traffic violations such as speeding tickets.)
* must provide value
Yes
No
If the answer to either of the above questions is YES, please give a full explanation.
**DEMOGRAPHIC INFORMATION**
In your first 12 years, how would you best describe your home town?
* must provide value
Rural (outside of city limits, less than 9,999) Small Town (population between 10,000 to 24,999) Suburban (population between 25,000 to 49,999) Metropolitan (population between 50,000 and over) Inner City (neighborhood with more than 50% lower income housing) Inner City (neighborhood was medically underserved)
In your first 12 years, what type of home did your family live in?
* must provide value
Subsidized housing Rented house Owned home
In your first 12 years, did you come from a single-parent household?
* must provide value
Yes
No
Was a language other than English commonly spoken in your home?
* must provide value
Yes
No
Are you fluent in another language other than English?
Yes
No
Are you the first person in your family to have attended college?
* must provide value
Yes
No
**ESSAY STATEMENT OF INTEREST
For the Essay section, write a 1-2 page essay that includes discussion of the following:
-previous research experience(s) if any
-current research interests
-why you want to pursue a graduate degree
-why you are applying to MUSC PREP
-your long range goals
* must provide value
For the Resume/Personal History below, please provide the following information in resume or curriculum vitae format:
-Academic history
-Past employment
-Undergraduate or summer research experience(s)
-Publications
-Academic honors, awards
-Extracurricular/community/professional activities
-Membership in professional organizations
* must provide value
**RESEARCH INTERESTS**
Applicants are asked to indicate their specific areas of interest to assist in making the interview process more meaningful for the applicant. Choices indicated here serve only as a guide for the interview process and are not binding. Choose all that apply.
* must provide value
Comments or questions you have about the PREP Program or the application. (Optional)
**AFFIRMATION**
I understand that information submitted herein will be relied upon by University officials to establish my status for admission and residency eligibility. I authorize the University to verify information I have provided. I agree to notify the MUSC PREP Program of any changes in the information provided.
* must provide value
Yes
No
I understand that, if accepted, final official transcripts must be provided to the University, verifying my Bachelor's degree.
* must provide value
Yes
No
I certify that the information in the application is complete and correct to the best of my knowledge and belief. In addition, I certify that fraudulently claiming US Citizenship is subject to a civil penalty, as well as the full repayment of all benefits received unlawfully. I acknowledge that the penalty for knowingly or purposefully providing false information when applying for admission to the program calls for immediate removal.
* must provide value
Yes
No
Submit
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