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University of Alabama at Birmingham (UAB) Academy for Addressing Health Disparities through Health Care Leadership
Application for Admission
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1.
Name:
(Required.)
Last name:
First name:
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2.
Address:
(Required.)
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3.
Telephone Number:
(Required.)
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4.
Email:
(Required.)
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5.
Where did you attend high school? (city, state, zipcode)
(Required.)
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6.
Are you currently enrolled at UAB?
(Required.)
Yes
No
Other (please specify)
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7.
What year are you in college?
(Required.)
Freshman
Sophomore
Junior
Senior
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8.
When do you expect to graduate?
(Required.)
Semester:
Year:
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9.
What is your major?
(Required.)
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10.
What is your most recent cumulative Grade Point Average (GPA)?
(Required.)
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11.
Tell us your race or ethnicity (check all that apply):
(Required.)
American Indian or Alaskan Native
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
Hispanic/Latina/Latino
White
Other (please specify)
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12.
Are you the first person in your immediate family to attend college?
(Required.)
Yes
No
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13.
Please provide names and contact information for two professors who know you. (name, phone number, email)
(Required.)
Professor 1
Professor 2
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14.
Please discuss the factors that influenced your educational decisions to date. Also, describe your professional career goals for the future. (500-1000 words)
(Required.)