Application to MD Program Mercer University

To submit your completed application form for the MD program at Mercer University, ensure that all sections are filled accurately. You may submit the application via postal mail to the Admissions Office at Mercer University or fax it to the designated number provided in your application instructions. Be sure to follow up to confirm that your application has been received and is being processed.

Important dates for the Mercer University MD program application include submission deadlines and interview notification dates, which typically occur annually. This information is crucial for applicants to ensure timely and successful application submissions. Please refer to the official website for the most up-to-date scheduling details for the 2024 and 2025 cycles.

The purpose of this form is to gather essential information from applicants for the MD program at Mercer University. It serves to affirm residency and domicile requirements necessary for admission consideration. Such declarations help the admissions committee assess applicants’ eligibility and commitment to residing in Georgia.

• 1. Legal Name of the Applicant: The full legal name as per state identification.
• 2. Other Names used: Any other names that the applicant may have used.
• 3. AAMC (AMCAS) ID: The unique ID assigned by the American Association of Medical Colleges.
• 4. Date of Birth: The applicant's date of birth in mm/dd/yyyy format.
• 5. Place of Birth: City, State, and Country where the applicant was born.
• 6. Are you a US Citizen?: A Yes/No question to ascertain citizenship status.
• 7. Are you a US Permanent Resident?: A Yes/No question for applicants not claiming US citizenship.
• 8. Permanent Address: Current residential address for the applicant.
• 9. County of Permanent Residence: The county where the applicant resides.
• 10. State of Legal Residence: The state that the applicant legally resides in.
• 11. Year you first lived in Georgia: The year the applicant first established residency in Georgia.
• 12. Continuous GA Residency Status Year: The year the applicant has continuously maintained residency status.
• 13. Name of High School attended: The name of the high school from which the applicant graduated.
• 14. Valid Driver's License: Whether the applicant holds a valid, unexpired driver's license.
• 15. State which issued this Driver's License: The state that issued the applicant's driver's license.
• 16. Do you own an automobile?: A Yes/No question regarding automobile ownership.
• 17. State in which this automobile is registered: The state where the applicant's automobile is registered.
• 18. State in which you are currently registered to vote: The state where the applicant is registered for voting.
• 19. Inclusive dates of last employment: The period of the applicant's last full-time employment.
• 20. Last filed GA Income Tax Return Year: The year the applicant last filed for GA state income tax.
• 21. Explain any break in GA Residency Status: Space for explanations, if applicable.
• 22. Other reasons for claiming GA residency: Additional reasons for claiming Georgia as legal residence.

Failure to submit this form may result in denied application processing. Without proper documentation, your residency declaration cannot be verified, adversely affecting admission eligibility. It is crucial to adhere to all submission guidelines and deadlines.

• Incomplete Application: An incomplete application may lead to rejection or delays.
• Missing Documentation: Not providing required documents could invalidate your residency claims.
• Late Submission: Submitting the application past the deadline will result in automatic denial.

• 1. Apply for Medical Program: Necessary for individuals seeking admission to the MD program.
• 2. Establish Residency: Essential for confirming Georgia residency for admissions.
• 3. Document Name Changes: Used when applicants have changed their legal names.