What kind of inquiry or application are you submitting?  

Initial Inquiry in order to obtain further information

An application for Admission to the PREP program

 

When would you like to be admitted if you application is successful?

 

         

August 2012 January 2013 (Other) Other:

 

Please enter your name and full permanent mailing address

Please enter your present mailing address, if different from above

Please enter your parent/guardian/other relative name and address

Please enter your date of birth

Please enter your gender

Male 

Female

Please enter your country of birth

 

Please enter country of citizenship
You must be a US citizen or permanent resident

Are you a permanent US resident?

Yes 

No

Are you a legal resident of South Carolina?

Yes 

No

What is your ethnic origin? (Hispanic, African, Native American, Other)
You must belong to an under-represented minority to be admitted to the PREP program

Have you attended an HBCU? If so, please give the name of the institution and dates
You do not need to have attended an HBCU to be admitted to the PREP program

Please list other universities that you have attended with dates of attendance, the degree that you obtained and your major subject

Please list four faculty members in the PREP program with whom you would like to meet if you are called for an interview
For this please refer to the PREP faculty page

 

Please enter other information such as GPA and GRE scores

Please enter any name that is different from that given above that may be on any of your transcripts (e.g. maiden name)

 

Please give the names of three persons whom you have requested to send letters of recommendation

 

Please tell us how to get in touch with you:

Name     

E-mail    

Tel        

FAX       

Please contact me as soon as possible regarding this matter.