Military to Medicine (M2M) Intake Form

Note: All fields marked with a * below are required. All other fields are optional.

General Information

First Name:

Last Name:

Email:

Phone:

Branch of Service:

Status:

Current Location:

Military Occupation (job title):

Academic Program:

Anticipated Application Date:

Files Upload

Files must be in PDF format and must not exceed a total size of 40 MB.

Service Verification (upload DD214 or active orders):

Academic Transcript (upload unofficial college transcript and JST/CCAF):

Upload Unofficial Standardized Exam Score Report (e.g., MCAT, GRE, etc.)

College Information

Cumulative GPA:

Science GPA:

Current Degree(s):

Standardized Admissions Exams (if applicable)

Have you taken a standardized admissions exam?

Yes

Scheduled

Select Exam Type:

Please specify the Exam Type:

Total Score:

Exam Date:

Anticipated Test Date (if not yet taken)

Other Information

Academic Notes:

Please verify that you have completed all required fields and are not a robot before submitting this form.