Summer-Scholars-Application


University of Missouri - Kansas City
School of Medicine
SUMMER SCHOLARS APPLICATION 2017
Personal Information:
First Name:*
Last Name:*
Middle Name/Initial:
Address:*
Telephone:*
-
Gender:
E-mail:*
Date of birth (mm/dd/yy}:
Jacket size:*

Are you Hispanic/Latino?

Which of the following do you consider to be your racial background? Place an “X” next to all races that apply:

Citizenship:
Are you a U.S. citizen?
If no, what is your country of citizenship?
Are you a resident alien?
If yes, please provide your card number:
Date of issue (mm/dd/yy):
Education Information:
High school attended:
Grade:

Please check the courses you have taken previously.

Have you taken the ACT or SAT?
What is your ACT or SAT score?

Do you consider yourself an advanced science student? If so, are nonetheless willing to participate in daily chemistry enrichment and review?

What courses have been difficult for you, if any?

Do you have an interest in other health careers? If so, please indicate your interests below:

Parent/Guardian Information *
Parent/Guardian telephone:*
-

* 1. Write a statement expressing your reasons for wanting to be in the Program. 
Include your general goals and career ambitions.

“I want to participate in the Summer Scholars Program because…”
“If you are a returning scholar, what was your most meaningful experience and what else do you hope to gain from this program?”

2. Significant school activities (student governent, athletics, clubs, tutoring, etc.)

- Please note the grade (9th, 10th, 11th) preceding the activities listed.

3. Offices held.

- Please note the grade (9th, 10th, 11th) preceding the activities listed.

4. Community contributions (health-related experiences, volunteer work, scouts, youth groups, etc.)

- Please note the grade (9th, 10th, 11th) preceding the activities listed.

5. Summer activities (travel, institutes, camp, etc.)

6. Employment (full and part-time - - with dates)

7. Current hobbies and leisure time interests.