STEPS Program Application for 2026-2027 Question Title * 1. DEMOGRAPHICS: (Required.) Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Cell Phone Number Question Title * 2. COLLEGE INFORMATION (Required.) Current College: Classification: City: State: Major: Minor: Degree: Anticipated Graduation Date: Current GPA: MCAT Score: Date MCAT was taken: If MCAT not taken yet or plan to take it again please give an anticipated date: Question Title * 3. MOTHER/GUARDIAN INFORMATION (Required.) Name: Address: City: State: Zip/Postal Code: Home Phone: Cell Phone: Email Address: Question Title * 4. FATHER/GUARDIAN INFORMATION (Required.) Name: Address: City: State: Zip/Postal Code: Home Phone: Cell Phone: Email Address: Question Title * 5. EMERGENCY CONTACT INFORMATION (Required.) Name: Relationship: Home Phone: Cell Phone: Email Address: Please explain any special circumstances you would like to be known in considering you for the STEPS Program (e.g. personal learning/physical disability, lengthy family illness, disabled parent, etc.): Question Title * 6. SHADOWING FOCUS AREA: What are your top 2 choices (Required.) Question Title * 7. STUDENT PROFILE Extracurricular Activities: List the extracurricular activities you have been in or currently involved and provide a description of our contribution to that activity. (Additional page may be attached if needed): Service (voluntary or paid) List your volunteer or paid work experience. Explain your specific responsibilities and date(s) completed or currently working. (Additional page may be attached if needed): Honors/Awards (BE SPECIFIC) List honors and/or awards you have received. Please do not list involvement in organizations or clubs unless you have been elected to an office or selected for a specific honor. Do not abbreviate name, for example: National Honor Society - NHS. (Additional page may be attached if needed): Writing Entry: Include a personal essay of 500 words about your background, interests and goals. This allows the application review committee to get a better understanding of the student's personality and expectations. Type on a separate document and double-space your writing entry and attach to the application. Question Title * 8. STUDENT CONSENT AND AGREEMENT: By my signature below, I hereby certify that the information provided is true and accurate to the best of my knowledge and that the writing entry is my original work. I commit myself to abide by the rules and expectations of the STEPS Program. (Required.) Name: Date: All application documents must be received by September 30, 2026. Application must include the following in order to be considered for the STEPS Program: 1.) Copy of college transcript 2.) Letter of recommendation from college faculty 3.) Completed STEPS Program application 4.) 500 word essay (why you want to become a DO or MD) typed, double spaced. Email documents to Kathleen.Couch@kctcs.edu by the deadline with the subject line STEPS Program Done
