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M*A*S*H | Mini M*A*S*H | CHAMPS

Arkansas Statewide Application

MASH Application for students across Arkansas

Step 1 of 4

25%

Personal Information and Demographics

Name(Required)
If you go by a name other than your legal name, you may enter it here:
This will be the email used to contact you. It should be an email you will have access to throughout the year.
Address(Required)
MM slash DD slash YYYY
Select "YES" if ANY of the following apply · 1st Generation to attend college · From high school with low SAT/ACT Scores or below the average state test results (School’s numbers) · From school district where 50% or less of graduates go to college · Diagnosed physical/mental impairment that substantially limits participation in education experiences · English is not primary language and language is still a barrier to academic performance

Parent/Guardian Information

Parent/guardian will be required to sign student release forms. Information below is for parent/guardian contact purposes.
Name(Required)
Address
Emergency Contact Name(Required)

Camp Information

Students may only apply for one camp. Please select camp based on county of residence. If unsure which camp to select, please refer to the guide at regionalcampuses.uams.edu/mash-2023/
Food may be served during camp. Please list any food allergies or dietary restrictions below.
If you have any medical conditions we should be aware of, please list below - this includes allergies, pregnancy, diabetes, epilepsy, etc. *Please note: For your safety, we ask that you tell us about any medical conditions. Information is private and will not disqualify you from the program.

Education Information & Career Goals

This will be verified with current transcript.
Current grade level is the grade you are in when applying for MASH (Spring 2023). Students who are applying for M*A*S*H or Mini M*A*S*H must be currently enrolled in 10th or higher grade level.
Verification of Science Courses (M*A*S*H/Mini M*A*S*H Only)
Significant School Activities(Required)
Please list your significant SCHOOL activities, achievements, and awards of the past three years. You may add additional rows as needed.
Other Significant Activities(Required)
Please list your significant NON-SCHOOL (community, church, etc.) acheivements of the past three years. You may also describe any jobs or duties you have that describe your level of committment to a task. You may add additional rows as needed.
Please write in your own words why you are interested in attending M*A*S*H and why you want to learn about health careers. Your response to this question is very important in the selection process.

Disciplinary Policy

Disciplinary Policy Consent(Required)
M*A*S*H faculty and staff aim to maintain a safe, positive, and educational environment for all participants. Certain behaviors can result in your immediate dismissal from the M*A*S*H program and notification of your parent/guardian. These behaviors include, but are not limited to:
- Deliberate violation of UAMS's or host facility's safety rules or policies
- Possession of alcohol and/or illegal drugs
- Being intoxicated or under the influence of any controlled substances
- Use of tobacco products during program hours
- Violation of dress code or cell phone policy
- Inappropriate language or discussions
- Violation of HIPAA rules and regulations
- Harmful or inappropriate contact or communication with other participants or staff
- Deliberate destruction or damage to property
- Unexcused tardiness or absence

Attendance Policy

Transportation(Required)
I understand that this camp is a day camp and I am required to my own provide transportation to the camp each day.
Attendance(Required)
Student attendance is required for the entire camp. Students who have a family emergency must contact their camp director immediately.

Forms and Releases

Please see the list of needed documents that will be submitted as part of the online application. There may be additional forms if accepted to camps.
Upload your Counsleor Academic Endorsement Form and Teacher/School Recommendation forms (varies by camp) here.
Drop files here or
Accepted file types: jpg, png, pdf, docx, Max. file size: 15 MB.
    Please upload a copy of your school transcript here. This can be obtained from your school counselor.
    Drop files here or
    Accepted file types: jpg, png, pdf, Max. file size: 15 MB.
      Please upload your signed photo release. If you are unable to be photographed for any reason (ie foster care, legal) please upload your document with a written note.
      Drop files here or
      Accepted file types: jpg, gif, pdf, docx, png, Max. file size: 15 MB.
        Please upload your Parent Consent Form here.
        Drop files here or
        Accepted file types: jpg, pdf, png, docx, Max. file size: 15 MB.
          Please upload your Confidentiality and Hold Harmless Agreement here.
          Drop files here or
          Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB.
            Additional Forms and Waivers(Required)
            Students may upload any additional documentation requested by Camp Directors.
            Drop files here or
            Accepted file types: pdf, gif, png, docx, jpg, Max. file size: 15 MB.
              COVID-19 Policies(Required)
              Each orgainziation has rules and regulations for the safety of students participating in M*A*S*H Camps and activities regarding COVID-19. You will be notified what the requirements for your camp are by email.

              Requirements will differ by organization, but may include requirements for proof of vaccination, approved religious or medical exemption, or use of mask while on campus or in patient areas. If you have any questions you may contact your camp director after completion of the online portion of the application.
              Application for Acceptance(Required)
              University of Arkansas for Medical Sciences LogoUniversity of Arkansas for Medical SciencesUniversity of Arkansas for Medical Sciences
              Mailing Address: 4301 West Markham Street, Little Rock, AR 72205
              Phone: (501) 686-7000
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