HUNTSVILLE RURAL PREMEDICAL INTERNSHIP

HUNTSVILLE RURAL PREMEDICAL INTERNSHIP PROGRAM - 2018

Name(*)

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Current Address

Complete Mailing Address

Include city, state & zip

Contact Phone

Alternate Phone

Email(*)

Place of Birth

Date of Birth

High School

High School Location

ACT or SAT Score

College Name

College Year

Major
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Minor
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GPA
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MCAT

Score or planned test date

Science GPA

Based on all courses in Biology, Chemistry, Physics and Math

Grades in the Following Courses

CH101

CH102

BY101

BY102

PH 101 or 111

PH 102 or 112

CH ORG1

CH ORG2

CH ORG3

Biochem

Bioethics

Micro

Math Calc

Math - Other

What do you consider your home town?
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Where is the longest place you have lived?
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Include location, number of years and what ages you were

Where do your parents live now? How many years?
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