UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS
Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814
GEO Applicant Information
1. Program Applying For:
Part I - Personal Information
Academic year applying for:
Application Date:
Last 4
Last Name:
First Name:
of SSN
M.I
Maiden Name:
Date of Birth:
Gender:
Indicate racial/ethnic background:
Citizenship:
Visa Type:
Email Address:
US Phone:
DNS Phone:
International Phone:
Current Address
Street:
City:
State:
Country:
Zip:
- Are you currently on active duty in the U.S. Uniformed Services?
Branch of Service:
Rank:
Corps:
- Will you be attending USUHS as a Uniformed member?
- If you are not currently a member of a Uniformed Service, please indicate the Branch of Service you intend to join:
- Have you received approval to attend USU by your Long Term Educational Training Board?
Date Request Submitted:
Part II - Education
Post-Secondary Schools
1 . College/Institution Name (institution, city, state):
Dates of Attendance:
Major:
Date of Degree:
GPA in Major:
Degree:
Overall GPA:
2 . College/Institution Name (institution, city, state):
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UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS
Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814
Dates of Attendance:
Date of Degree:
Major:
GPA in Major:
Degree:
Overall GPA:
3 . College/Institution Name (institution, city, state):
Dates of Attendance:
Major:
Date of Degree:
GPA in Major:
Degree:
Overall GPA:
4 . College/Institution Name (institution, city, state):
Dates of Attendance:
Major:
Date of Degree:
GPA in Major:
Degree:
Overall GPA:
*** You must make arrangements for official transcripts from each college, university or graduate school you have attended to be sent by the institution
directly to the Associate Dean for Graduate Education. Electronic forms are preferred. Deadline for receipt of transcripts is DECEMBER 1st.
Graduate Record Examination (GRE) / TOEFL Status
Note: The Graduate Record Examination must have been taken within two years of the date of this application. Score must be sent to the Associate Dean for
Graduate Education, USUHS. USUHS school code for GRE's is 5824.
GRE Waiver Requested?
GRE Test Date:
GRE Scores
Verbal:
Quantitative:
Analytical:
GRE Percentile
Verbal:
Quantitative:
Analytical:
Recommendation Letters: You must request three individuals who are acquainted with you and your academic/professional work to send
statements of your qualifications for graduate study DIRECTLY to the Associate Dean for Graduate Education, Uniformed Services University of the
Health Sciences. These letters should include a statement of your aptitude and promise for independent research. Provide the following information
concerning your references:
1 . Name of Recommender:
2 . Name of Recommender:
3 . Name of Recommender:
Part III - Employment Experience
Employment Experience: List all relevant research or teaching experience since college.
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UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS
Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814
1. Job Title:
Name of Immediate Supervisor/Institution/Company:
Start date:
End date:
Job Description:
Part IV - Program Information
1. Program Applying For:
Degree being sought:
Field of Interest:
Statement: (Please provide a personal statement that describes your background of interest, and any other information that you feel
is relevant to your application to the Uniformed Services University)
Have you previously applied for admission to graduate study at USUHS? What academic year? What was the result?
Have you ever withdrawn from or repeated a term in any college or university?
Have you ever been dismissed from or denied readmission to any college or university?
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UNIFORMED SERVICES UNIVERSITY, SCHOOL OF MEDICINE GRADUATE PROGRAMS
Graduate Education Office (A 1045), 4301 Jones Bridge Road, Bethesda, MD 20814
Do you consider anything about your academic record or career pattern to be unusual?
Have you received any academic honors, prizes, or scholarships?
Have you been elected to any honor societies?
Have you published any abstracts, articles, books? Do you have any inventions patented?
Privacy Act Statement: The information solicited in all Uniformed Services University of the Health Sciences application materials is
governed by the Privacy Act. The following information is provided for your guidance
1. The collecting of information about applicants is authorized by Title 5 USC 301 and 10 USC 2114.
2. The Purpose of applicant records is to provide information upon which to base USUHS admissions decisions. Social Security
Numbers are used to identify records and as a safeguard against error in compiling individual applicants' records.
3. Routine uses of this information will include, in addition to admissions decisions, related research and statistical endeavors
designed to improve the admissions process.
4. The submission of information is voluntary on the part of applicants. However, applicants should be aware that failure to complete
this form may delay processing and /or increase the probability of accidental mishandling of applications or result in denial of your
application.
I have read and understand the instructions (including the Privacy Act Statement). I certify that the information submitted in this
application form is complete and correct to the best of my knowledge. I certify that the thoughts and words provided are mine, they
have not been prepared or substantially modified by others. I understand that any misrepresentation may be cause for denial of
admission.
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