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Minority Rural Health Scholars Program Application

Application Deadline is March 15, 2022. We will contact you after your application is reviewed and confirm that it is complete. Final selections for the 2021 Minority Rural Health Scholars will be made by April 30, 2022.

If you have any questions about the application process or the Minority Rural Health Scholars Program, please contact Cynthia Moore at (205) 348-3116 or cmoore@ua.edu.

Ask your high school guidance counselor to submit a copy of your high school transcript, including scores on the ACT, SAT or other standardized tests you have taken:

Minority Rural Health Scholars Program
The University of Alabama
Box 870327
Tuscaloosa, AL 35487-0327

If you are human, leave this field blank.

Your Information

Name *

Date of Birth *

Mailing Address *

Country

City

Zip code

County *

Phone Number *

Email Address *

Demographic Information

Sex *

Female

Male

Race *

Black/African American

Hispanic/Latin

Native American

White/Caucasian

Asian/Pacific Islander

Education

I am in the 12th grade. *

Yes

No

High School Name *

High School City *

High School County *

Cumulative GPA *

Graduation Date

ACT Score

SAT Score

Other Standardized Test Scores

Unofficial High School Transcript *

Which courses have you taken?

Biology

Chemistry

Physics

Anatomy and Physiology

Algebra I

Algebra II and Trigonometry

Geometry

List all extracurricular activities.

Parent/Legal Guardian Information

Mother's Name

Father's Name

Parent/Guardian Phone Number *

Parent/Guardian Email *

Address of Parents

Apt, suite, etc.

Country

City

State

Zip code

Did your mother attend college? *

Yes

No

Where did your mother attend college, and what was the highest degree she achieved? *

Did your father attend college? *

Yes

No

Where did your father attend college, and what was the highest degree he achieved? *

Future Plans

List colleges or universities to which you have applied or are applying.

List colleges or universities you have received acceptance letters from.

Essays

Why do you want to participate in the Minority Rural Health Scholars Program? *

What type of health care professional would you like to be and why? *

What characteristics do you admire in people from rural Alabama? *

Letters of Recommendation

Letter of recommendation from your high school guidance counselor. *

Letter of recommendation from your math teacher, science teacher, english teacher, health sciences teacher, or principal. *

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

Sign your name below. *

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

Yes

Captcha *

reCAPTCHA is required.

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