EQUIP Application for Admittance (College/University Student) 2026

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EQUIP Application for Admittance (College / University Student)

Quillen College of Medicine
East Tennessee State University
The mission of EQUIP, Extending Quillen into Underserved Areas through an Integrated Program, is to identify, mentor, and prepare students who are committed to becoming primary care physicians serving rural and underserved communities.

Qualifications:
Must meet these criteria and supply proof when asked:

I am from a rural underserved community in the state of Tennessee, Southwest Virginia, or Northwest North Carolina.

I understand that EQUIP is a required minimum commitment of at least 2.5 years of time enrolled in the program prior to Medical School.

Applicant Information

1. Legal First Name:

2. Legal Last Name:

3. Preferred Name (optional):

4. Preferred pronouns (optional):

5. Date of Birth:

6. Age at the time of application:

7. University Email Address:

8. Active Email Address, if university address is not yet available:

9. Cell Phone Number:

e.g. (999) 999-9999

10. Current Mailing Address:

11. Address 2 - Apt, Unit etc. (Optional):

12. City:

13. State:

14. ZIP Code:

15. Is your permanent address different from your current mailing address?

Yes

16. If yes, provide your permanent mailing address:

Education

1. Which high school did you attend?

2. High school City, County, and State:

3. High school GPA:

4. ACT Score:

5. SAT Score, if applicable:

6. Current college or university:

7. Are you currently an ETSU Student?

Yes

8. If yes, enter your E-number:

9. List any other colleges or universities you have attended:

10. Current academic classification:

11. Major:

12. Minor or concentration:

13. Anticipated graduation month and year:

14. Current cumulative college GPA, if available:

15. Current science GPA, if available:

16. Approximately how many college credit hours have you completed?

17. What calendar year do you anticipate applying to medical school?

18. What calendar year do you anticipate beginning medical school?

The following questions help EQUIP understand applicants’ backgrounds and access to educational and professional opportunities. Responses will be reviewed in the context of each applicant’s overall experience.

1. Are you the first person in your immediate family to pursue a four-year college degree?

2. Are you the first person in your immediate family to pursue a career as a physician?

3. Do any of your parents, guardians, or siblings work in healthcare?

4. If yes, please briefly describe their role or profession:

Rural or Underserved Community Background

1. In what city or community did you primarily grow up?

2. In what County and State is this community located?

3. How would you describe your connection to this community?
Select all that apply

a. I grew up in this community.

b. My family currently lives in this community.

c. I attended a school in this community.

d. I currently live in this community.

e. I have worked or volunteered in this community.

f. I have another significant connection to this community.

4. If you selected “another significant connection,” please explain:

5. Describe the rural or underserved characteristics of your community and how they have influenced your experiences, opportunities, or access to healthcare:

Suggested limit - 300 words.

Experiences

Please select all experiences in which you have participated:

Participation in Quillen College of Medicine programming:

Rural High School Medical Camp
Doc for a Day
Rural Youth Career Expo

Participation in a Remote Area Medical (RAM) event.

Physician shadowing for 20 hours or more

Clinical employment or other paid healthcare experience

Healthcare volunteering or direct patient care for 20 hours or more, such as in a hospital, long-term care facility, EMS, or physical therapy setting

Nonclinical community service or volunteer work

Leadership experience in a school, campus, workplace, or community organization

Research experience

Caregiving or significant family responsibilities

Participation in a school or campus organization

Participation in athletics, band, cheerleading, or other extracurricular activities

Employment or service in a rural community, including work in leadership, education, healthcare, economic development, or community service

Other relevant experience

None of the above

EQUIP Interests

What are you most interested in receiving through EQUIP?
Select up to three

Medical student or physician mentorship

Academic advising

MCAT preparation

Medical school application guidance

Physician shadowing

Clinical exposure

Community engagement

Leadership development

Information about rural healthcare

Connections with other students

Other

Describe up to three experiences that have most influenced your interest in medicine, primary care, or serving rural and underserved communities. What did you learn from these experiences?

Suggested limit - 500 words

Is there anything else you would like the EQUIP Selection Committee to consider when reviewing your application? You may use this space to discuss circumstances, responsibilities, challenges, achievements, or experiences not addressed elsewhere:

Suggested limit - 250 words

Please acknowledge each statement.

Required checkboxes

I certify that the information provided in this application is complete and accurate. I understand that I may be asked to provide documentation supporting the academic and eligibility information included in my application.

I understand that EQUIP requires at least 2.5 years of participation before I begin medical school.

I understand that EQUIP has limited capacity and that meeting the minimum qualifications does not guarantee admission to the program.

I understand that participation in EQUIP does not guarantee admission to the Quillen College of Medicine, and my future AMCAS application will be reviewed according to the admissions standards in effect at the time I apply.

I understand that EQUIP is intended for students seriously interested in primary care, rural or underserved medicine, and attending the Quillen College of Medicine.

If accepted, I agree to participate consistently in required advising, educational sessions, community engagement, and program communications.

I understand that EQUIP requires completion of the Appalachian Preceptorship during the summer before I apply to medical school, during which I will complete 100 hours of physician shadowing and attend the required on-campus educational component.

I understand that EQUIP participants may not simultaneously participate in another medical school pathway, early-assurance, or guaranteed-admission program.

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