The Secondary Application is required for individuals applying only to the MD/MSTP program at
McGovern Medical School. Individuals who are also applying to the MD program through TMDSAS do
not need to complete the secondary application.
SECONDARY APPLICATION PROCESS
1. Complete secondary application.
2. Print completed secondary application and sign.
3. Mail secondary application with $65.00 application fee to the address listed below.
o Checks should be made payable to McGovern Medical School Office of Admissions.
o Your secondary application will not be processed until payment is received.
The secondary application and fee must be post-marked by November 1 and must be received by
November 15. This information is required to complete the application process.
MAIL COMPLETED SECONDARY AND FEE TO:
McGovern Medical School
Office of Admissions and Student Affairs
Attn: Nicole Dubuque
6431 Fannin, MSB G.400
Houston, Texas 77030
MD/MSTP SECONDARY APPLICATION
1
APPLICANT INFORMATION
Last Name
First Name
Middle Name
Street Address
Apartment/Unit #
City
State
Zip
Phone
Email Address
APPLICATION HISTORY INFORMATION
Have you previously applied for admission to any TMDSAS participating
medical school?
Yes
No
Have you previously applied for admission to any TMDSAS participating
dental school?
Yes
No
If yes, indicate entry year(s) to which you applied to each school:
Entry Years Applied
Entry Years Applied
Re-applicant Information
If you are reapplying, what have you done to strengthen your application?
MD/MSTP SECONDARY APPLICATION
BACKGROUND INFORMATION (Yes or No answers. Please explain if answer Yes)
Has your education or vocation ever been interrupted for any reason? If
yes, explain fully below.
Yes
No
Are you currently under charge or have you ever been convicted of a felony
or misdemeanor, or have you ever received a felony or misdemeanor
deferred adjudication?
You need NOT disclose information about any of the following:
• you were arrested but not charged
• you were arrested and charged, but the charges were dropped
• you were arrested and charged, but found not guilty by a judge or jury
• you were arrested and found guilty by a judge or jury, but the conviction was
overturned on appeal
• you received an executive pardon
• a juvenile or criminal record that has been sealed or expunged. Failure to disclose
information that is not in fact expunged or sealed may result in the applicant being
denied admission
• minor traffic violations
Failure to disclose information that is not in fact expunged or sealed may result in the
applicant being denied admission.
Yes
No
If yes, explain fully below including dates.
Were you ever the recipient of any action by any college or professional school for:
a. Unacceptable academic performance (academic probation,
suspension, dismissal, etc.)
Yes
No
b. Conduct violations?
Yes
No
If yes, please explain fully below.
Secondary Application Essays
Please complete all three essay prompts below. A completed secondary is required to be considered
for an interview. Your application will not be evaluated until you have completed the secondary.
The character limit for each prompt is 2500 characters (including spaces).
Prompt 1: How have your experiences prepared you to be a physician scientist?
Prompt 2: Describe a time or situation where you have been unsuccessful or failed. What did you
learn from this experience and how have you applied this learning to your work and/or life?
Prompt 3: What would you like to contribute and be remembered for in medicine/science?
Prompt 4: Why would our MD/PhD program be a good fit for your career goals?
_______________________________________________ ____________________________
Signature Date