South TX Doctoral Bridge Application form_REVISED_7-8-2014

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Application Form

How to Apply

(1) Complete this application and submit to SouthTXDocBridge@txstate.edu

(2) Have 2 letters of recommendation submitted to SouthTXDocBridge@txstate.edu

.

Please provide ALL of the following information. Click the light blue boxes to enter a response or check.

Contact Information

Email (we will primarily contact you by email) Enter email

Phone Enter phone.

Demographic Info

Name (Last, First Middle) Last, First Middle.

Ethnicity/RaceSelect ALL of the following groups with which you identify as part of your cultural or family heritage. You may choose more than one.

Hispanic/Latino

Black/African American

White/Caucasian

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Other: Click here to enter other ethnic or racial groups

US Citizen, Resident, or Visa? Check ONE of these:

☐ I’m a US Citizen or a Permanent Resident ☐ I’m NOT a US Citizen or Permanent Resident

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Revised 7/8/2014

Academic Info

Undergraduate Education

Undergraduate Institution: School Name o Degree program:

☐ BS ☐ BA

Major: Enter Major.

2 nd Major, if applicable: Enter Major.

Minor: Enter Minor.

2 nd Minor, if applicable: Enter Minor.

Undergraduate GPA (on a 4.0 scale)? Enter GPA.

Have you completed your undergraduate degree? ☐ Yes ☐ No

When did you graduate or When do you expect to graduate? Month, Year.

Graduate Education: Have you taken any graduate courses? ☐ Yes ☐ No If yes:

Graduate Institution (if applicable) School Name

What program are/were you enrolled in? Degree type/program name/school or

I was not part of a program.

Graduate GPA (on a 4.0 scale)? Enter GPA.

Other Academic Information: We will be looking at your transcripts submitted when you applied to the MS program at

Texas State University. If there is anything else important that you want us to know regarding either your undergraduate or graduate school history (e.g, you switched to a science major very late, or you attended multiple undergraduate

schools, or you had poor grades in Spring of Junior year because of a serious illness), please address it in the space provided at the end of this application form.

Professional admissions exams

If you have taken any professional admission exams (e.g., GRE, MCAT, PCAT, VCAT), please enter the details below.

Date Taken

Most recent date.

Earlier test date.

Earlier test date.

Academic and Career Goals

Exam (GRE, MCAT,

PCAT, etc.)

Enter exam name.

Enter exam name.

Enter exam name.

Total/Composite

Score

Overall score.

Overall score.

Overall score.

Individual Scores

Enter score breakdown.

Enter score breakdown.

Enter score breakdown.

Admission to this program requires that you are accepted to and enroll in a Master’s program at Texas State

University.

Have you applied yet to a Master’s program here? ☐ Yes or I’m already enrolled ☐ No

Revised 7/8/2014

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If yes, Which program?

Enter your response When will/did you start? Enter your response

If no: Which program will you apply to?

Enter your response When would you start? Enter your response

Do you plan to continue your biomedical education after you complete your Master’s degree?

☐ Yes, that’s my plan ☐ I’ve thought about it, but I’m not sure ☐ No

If yes or maybe: o Which of the following types of programs are you interested in entering? Check all that apply.

☐ PhD

☐ MD (medical school)

☐ MD/PhD (joint program in medicine and research)

☐ Pharm.D (pharmacy school)

☐ another Master’s program

Other: Enter other program type here

 o What fields of study are you most considering pursuing for further education (e.g., “Structural Biology”,

“Biochemistry”, “Biomedical Engineering,” “Pharmacology”)? List up to 5 fields of interest to you, in order of preference. (For help identifying some different fields, see www.nabr.org/Biomedical_Research/Careers.aspx

.)

Top choice field of study.

Next choice field of study.

Next choice field of study.

Next choice field of study.

Next choice field of study.

If no: What do you want to do when you complete your Master’s degree? Enter your response

Anything else? (this is optional)

Is there anything else you want the Bridge selection committee to know when evaluating your application? (optional)

Feel free to add it below. If you have publications, please include the citations for them here, or include your CV with

your application materials.

Type your response, or cut and paste to here.

After submission of application materials, you should receive a reply within 2 business days. If you do not, check that the email address was correct, and follow up with us.

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Revised 7/8/2014

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