HCOP National Ambassador Program Application
Thank you for your interest in the Meharry Health Careers Opportunity Program (HCOP) National Ambassadors Program. The program supports undergraduate students from economically or educationally disadvantaged backgrounds who are preparing to pursue medical, dental, or graduate health programs. HCOP is funded by the Health Resources and Services Administration (HRSA). Applicants are selected based on program eligibility, documented disadvantage indicators, and a review of the completed application. Please complete every required section and upload all requested documents, including your transcript and supporting eligibility documentation. Application deadline: September 7, 2026. If you cannot upload your transcript or another required document by September 7, 2026, email soddeansoffice@mmc.edu by September 7, 2026. Identify the missing document and confirm when you will be able to provide it. We cannot move forward with your application unless we receive the required documentation or communication from you by the deadline. Submitting an application does not guarantee acceptance. Selected applicants will receive additional information by email.
Vaccination Information
Are you fully vaccinated against COVID-19?
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Yes
No
Vaccination Type
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Please Select
Moderna
Pfizer
Johnson & Johnson
Other
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Personal Information
Full Name
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First Name
Middle Name
Last Name
Date of Birth
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
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Male
Female
Prefer not to say
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
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example@example.com
Emergency Contact Name
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Emergency Contact Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship
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Are you a U.S. Citizen?
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Yes
No
Are you a lawful permanent resident of the United States (ie a Green Card holder)?
Yes
No
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Home Address
Street Address
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City
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State
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Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
ZIP Code
*
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University Information
University Name
*
Current Classification
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Please Select
Sophomore
Junior
Senior
Graduate
Current Major
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Minor (Optional)
Current GPA
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Expected Graduation Month and Year
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Are you a first-generation college student?
Yes
No
Unsure
Are you currently eligible for, or have you previously received, a Federal Pell Grant?
Yes
No
Unsure
Please upload documentation verifying your Pell Grant eligibility.
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What type of high school did you primarily attend?
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Public high school
Private high school
Charter school
Homeschool
Other: __________
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Family Information
Are you financially or personally responsible for any dependents?
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Yes
No
If yes, list the ages of any minor dependents
Family Structure
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Single Parent Household
Two Parent Household
Number of Siblings
Parent/Guardian Occupation & Employer
Other Parent/Guardian Occupation & Employer
Annual Household Income
*
Please Select
$0–19,999
$20,000–29,999
$30,000–39,999
$40,000–49,999
$50,000–59,999
$60,000–69,999
$70,000–79,999
$80,000–89,999
$90,000–99,999
$100,000+
Prefer not to disclose
Demographic Information
Ethnic Origin
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Hispanic
Non-Hispanic
How do you identify your race? (You may choose multiple categories)
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
White
Unknown
Other
Which option best describes the community where you primarily grew up?
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Urban
Suburban
Rural
Other
Unsure
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Educational Financial Information
Approximately what percentage of your college expenses are covered by your parents?
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Approximately what percentage of your college expenses are covered by scholarships?
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Approximately what percentage of your college expenses are covered by student loans?
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Applicant Certification: I certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that submitting an application does not guarantee acceptance and that Meharry Medical College may request additional documentation to verify my eligibility. I authorize the HCOP selection committee to review the information and documents submitted with this application. I have read and agree to the statement above.
I agree
I do not agree
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Required Application Documents
Official College Transcript
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Personal Statement Essay: In 500 words or fewer, explain your interest in pursuing a medical, dental, or graduate health career. Describe how your personal background, educational experiences, or challenges have influenced your goals. Additionally, explain how participating in the HCOP National Ambassadors Program would support your academic and professional development.
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Letter of Recommendation #1
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Letter of Recommendation #2
*
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Electronic Signature
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Date Signed
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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