Contact Information
Full Name *
What term/semester are you applying to? *
Fall Program (Deadline August 15th)
Spring Program (Deadline December 15th)
Summer Program (Deadline May 1st)
Permanent Address *
City *
State *
Zip Code *
Country *
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:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific
White
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.
I belong to a race or ethnicity considered underrepresented in medicine.
I identify as part of the lesbian,gay, bisexual, transgender, queer, intersex, or asexual (LGBTQIA) community.
I am the first person in my immediate family to attend college (excluding siblings).
I was born or grew up in a rural community.
I am a military veteran (including active duty and those transitioning to civilian life).
I come from an economically disadvantaged background.
I attended an underperforming elementary, middle, or high school.
My primary language is NOT English.
I have overcome a significant hardship.
Experience and Interests
Describe your educational and career goals? *
Are you considering applying to an MS in Genetic Counseling Program? *
Yes
No
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: *