MPESC 2025 High School Application

Thank you for your interest in the 2025 MPESC-PREP Internship Program at the IU School of Medicine. Please complete this application as accurately as you can.

The application deadline is January 15, 2025. Students will be notified if they are accepted for the next steps and interview or non-acceptance by March 31, 2025. The program will run for 8 weeks from June 2-July 25, 2025.

Please note that only students currently in grades 10, 11 and 12 are eligible.

Thank you!

Shari Parker

Programs Manager, Summer Internship Programs

Official FIRST NAME - Please provide your first name the way it appears on your social security card or other similar official documents.

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Official MIDDLE NAME or INITIAL - Please provide your middle name or initial the way it appears on your social security card, or other similar official documents.

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Official LAST NAME - Please provide your LAST NAME as it appears on your social security card or other similar official documents. If your last name is more than one word, please include it here with with caps, or no caps the way it appears on your documents -example: de la Vega.

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Preferred name/nickname - please list a preferred name or nickname that you would like to be addressed on your nametag, correspondence, etc. if different than above.

HOME STREET ADDRESS - Please provide your home address (permanent address) where correspondence can be mailed.

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HOME CITY - Please provide your home city (permanent address) where correspondence can be mailed.

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HOME ZIP CODE - Please provide your home zip code (permanent address) where correspondence can be mailed.

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SCHOOL EMAIL - If you have a school issued email, enter here.

PERSONAL EMAIL - IMPORTANT: Make sure the email address you provide here is working for you. This is the email where you will receive the follow up links for your application.

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Please CONFIRM your PERSONAL EMAIL again.

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Please double check your personal email entries - they do NOT match

Please enter your CELL PHONE NUMBER or number where you can best be reached.

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Please CONFIRM your CELL PHONE NUMBER

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Please double check your cell phone entries - they do NOT match

DATE OF BIRTH - please provide your date of birth in the following format (MM-DD-YYYY)

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M-D-Y

GENDER

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PREFERRED PRONOUNS

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RACE

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Other Race

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ETHNICITY

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Are you a citizen of the United States?

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Are you a Permanent Resident of the United States with a Permanent Resident ''Green Card'' or USCIS Form I-551?

Please describe and explain your citizen or immigration status. Please provide sufficient information for program directors to know how to best support you.

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Name of Parent(s) or Guardian(s) that you live with. If you have a shared custodial arrangement, please add name/s of other custodial parents on the next question.

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Name(s) of Additional Custodial Parents or Legal Guardians with shared custody.

What is the best phone number where one of your parents can be reached

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Parent email. Please provide an email address for the parent/guardian where you live who will complete the parent portion of the application. Please enter the correct email.

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Parent email 2. If possible, provide an email address for a second parent.

Which high school do you attend?

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In which COUNTY is your school located?

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In which county is your school located? *Only Indiana residents are considered for the MPESC program.

Expected Graduation Year. Please note: ONLY students in grades 10, 11 or 12 are eligible to apply.

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How will you travel to your internship location?

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