Contact Information
Full Name *
What term/semester are you applying to? *
Permanent Address *
City *
State *
Zip Code *
Primary Address *
Primary Email *
MCW is an affirmative action/equal opportunity institution and does not discriminate on the basis of age, sex, race, color, religion, national origin, veteran status, disability or sexual orientation. In order to evaluate the effectiveness of our recruiting efforts and ensure we are considering the needs of all our prospective students, please consider the following optional questions:
Background
Are you Hispanic or Latino?
Yes
No
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:
MCW values the unique backgrounds and identities of our incoming students. Please indicate if any of the following apply to you. Check all that apply.
Experience and Interests
Describe your educational and career goals? *
Are you considering applying to an MS in Genetic Counseling Program? *
Describe your relevant genetic counseling exposure, shadowing, or other relevant experiences that you have participated in. *
College/University
Area(s) of Study
Year in School
Freshman
Sophomore
Junior
Senior
Post-baccalaureate
Graduate School
Post-graduate
Unofficial Overall GPA (round to the nearest hundredth) *
Graduation Date (MM/YYYY) (or anticipated)
How did you hear about the Genetic Counseling Career Research & Exploration Workshop? *
Campus Visit
Current or Former Professor
Former Pure Participant
Friend
Internet Search
MCW Current Student
MCW Faculty
MCW Former Student
MCW Website
Instagram
Twitter
Other
If Other:
By entering your name in the signature box below, you are:
Validating that the information you have provided on this application is accurate and truthful to the best of your knowledge.
Confirming your willingness to share the information you have provided with MCW faculty and staff members involved with the selection and placement of PURE applicants.
Signature: *
