Rural High School Medical Camp Application

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Rural High School Medical Camp - Student Application

Quillen College of Medicine
East Tennessee State University

Application Deadline: April 25th, 2025

Instructions: Applications are only accepted online. All questions must be answered except where noted.

Student's Name (Last):

Student's Name (First):

Home Address:

Home City:

Home State:

Home Zip:

Phone # (include area code):

e.g. (999) 999-9999

Student's E-mail:
All correspondence will be through this e-mail address.

Optional: Do you identify with any of these groups which may be considered underrepresented in medicine? This optional information can help us plan activities and support services for the program.

Optional: Race / Ethnicity:

Optional: Disadvantaged Background: (Check all that apply)

Grew up in a rural or Appalachian area

immigrant to the United States

First-generation college student (neither of your parents earned a degree beyond high school)

Optional: Gender – This optional information can help us plan activities and support services for the program.

High School:

Rising senior or recent graduate:

What is your GPA (Grade Point Average)?
Minimum 3.0 required.

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