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This will allow us to communicate with you about various workshops and other pre-applicant events.First NameMiddle NameLast NamePreferred First NameContact InformationMailing AddressMailing AddressCountryStreetCityRegionPostal CodeState of legal residenceAlabamaAlaskaAmerican SamoaAPO/FPO (AA)APO/FPO (AE)APO/FPO (AP)ArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMariana IslandsMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin Islands, U.S.VirginiaWashingtonWest VirginiaWisconsinWyomingEmail AddressPrimary PhoneHow would you like to receive communications from the school? 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Msg & Data rates may apply.Personal InformationBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900GenderFemaleMaleDeclined to AnswerGender IdentityMaleFemaleTrans Male/Trans ManTrans Female/Trans WomanGenderqueer/Gender Non-ConformingDifferent IdentityPlease provide more details belowPreferred PronounsShe/Her/HersHe/Him/HisThey/Them/TheirsZe/Hir/HirsOtherPlease provide more details belowRaceRaceAmerican Indian or Alaska NativeAsianBlack or African AmericanHispanicNative Hawaiian or Other PacificOtherWhitePrefer Not To RespondPlease feel free to provide more detailsMilitary ServiceActive DutyUS Reserves or National GuardVeteranOtherNot ApplicablePlease select your military branchPlease select your military branchAir ForceArmyCoast GuardMarinesNational GuardNavyPlease select your citizenship statusUS citizenPermanent residentInternational (Visa Needed)DACA recipientRefugee/AsylumOtherCitizenship1 = United States (Hidden: Default if inq_citizenship_status = USA Citizen)AfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBassas Da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius, and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandClipperton IslandCocos Islands (Keeling Islands)ColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCoral Sea IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaEuropa IslandFalkland Islands (Islas Malvinas)Faroe IslandsFederated States of MicronesiaFijiFinlandForeign/UnknownFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambia, TheGaza StripGeorgiaGermanyGhanaGibraltarGlorioso IslandsGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R.HungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJan MayenJapanJerseyJordanJuan De Nova IslandKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau S.A.R.Macedonia, Republic of NorthMadagascarMalawiMalaysiaMaldivesMaliMaltaMan, Isle ofMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalau, the Pacific Islands ofPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSpratly IslandsSri LankaSudanSurinameSvalbardSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabwePermanent Resident Flag = Yes (Hidden: Default if inq_citizenship_status = Permanent Resident)YesNoOther citizenship status description Immigration Status = DACA (Default. Hidden)Student (F1)Exchange visitor/student (J1)Refugee/AsylumPermanent ResidentDACAAdjustment of StatusNoneOtherImmigration Status = Refugee/Asylum (Default. Hidden)Student (F1)Exchange visitor/student (J1)Refugee/AsylumPermanent ResidentDACAAdjustment of StatusNoneOtherImmigration Status = Student F1 Visa (Default. Hidden)Student (F1)Exchange visitor/student (J1)Refugee/AsylumPermanent ResidentDACAAdjustment of StatusNoneOtherApplicationPlease select your medical school application year2024-252025-262026-272027-282028-292030-31Education LevelPlease choose all levels of education you have completed and/or are currently enrolled in.Please choose all levels of education you have completed and/or are currently enrolled in.Attending High SchoolHigh School GraduateEarning Bachelor's DegreeAwarded Bachelor's DegreeAttending Post-BaccPost-Bacc CompletedAttending Graduate School (Masters or higher)Earned Graduate Degree (Masters or higher)Gap Year After High SchoolGap Year After CollegeHigh School NameHigh School Level of Study (hidden)High SchoolJunior CollegeUndergraduatePostbaccalaureateGraduateHigh School CEEB (hidden)Please provide additional school information below (if applicable)Undergraduate school nameUndergraduate Level of Study (hidden)High SchoolJunior CollegeUndergraduatePostbaccalaureateGraduateUndergraduate Institution CEEB (hidden)Post-Bacc School NamePost Bacc Level of Study (hidden)High SchoolJunior CollegeUndergraduatePostbaccalaureateGraduatePost Bacc Institution CEEB (hidden)Graduate School NameGraduate Level of Study (hidden)High SchoolJunior CollegeUndergraduatePostbaccalaureateGraduateGraduate Institution CEEB (hidden)Other InformationHow did you hear about the Kerkorian School of Medicine at UNLV? (check all that apply)How did you hear about the Kerkorian School of Medicine at UNLV? (check all that apply)UNLV WebsiteSchool of Medicine WebsitePre-Professional Advising CenterEmailFriendCurrent UNLV studentCurrent KSOM studentInstagramFacebookTwitterLinkedInYouTubePodcastOtherIf other please provide detailsSubmit