Rural Health Scholars Application | College of Community Health Sciences

Your Information

Name(Required)

First Last

Date of Birth(Required)

Mailing Address(Required)

Street Address City ZIP Code

County(Required)

Personal Phone(Required)

Personal Email(Required)

Demographic Information

Sex(Required)

Female

Male

Race(Required)

Black/African American

Hispanic/Latino

Native American

White/Caucasian

Asian/Pacific Islander

Other

Education

I am in the 11 grade.(Required)

Yes

High School Name(Required)

High School City(Required)

High School County(Required)

Cumulative GPA(Required)

ACT Score

SAT Score

Other Standardized Test Scores

Unofficial High School Transcript(Required)

Max. file size: 25 MB.

What courses have you taken?(Required)

Biology

Chemistry

Physics

Anatomy and Physiology

Algebra I

Algebra II and Trigonometry

Geometry

Did you participate in HOSA (Health Occupations Students of America) in high school?(Required)

Yes

List all extracurricular activities.(Required)

Parent/Legal Guardian Information

Guardian Name(Required)

First Last

Guardian Phone(Required)

Guardian Email(Required)

Guardian Address(Required)

Street Address City State ZIP Code

Did your mother attend college?(Required)

Yes

Did your father attend college?(Required)

Yes

Statements of Interest

Minimum 150 words

What field of healthcare interest you and why?(Required)

Why do you want to participate in the Rural Health Scholars Program? Include background information, goals and motivation, health career interest, and any exposure you may have had to the health-care field.(Required)

Letters of Recommendation

Letter of recommendation from your high school guidance counselor.(Required)

Max. file size: 25 MB.

Counselor Name(Required)

First Last

Counselor Email(Required)

etter of recommendation from your math teacher, science teacher, English teacher, health sciences teacher, or principal.(Required)

Max. file size: 25 MB.

I certify that the information submitted in this application is complete and correct to the best of my knowledge.

Sign your name below.(Required)

First Last

My parent or guardian has given permission for your me to participate in the Rural Health Scholars Program at The University of Alabama.(Required)

Yes

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