MEDICAL SCHOLARSHIP FORM Step 1 of 2 50% 1.- Name First Last 2.- Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 3.- Phone4.- Date of Birth 5.- Current College or Medical School:6.- I will be attending the following Medical School in the Fall of 2020:7.- I will be entering the above-mentioned school as a:FreshmanSophomoreJuniorSenior8.- Grade Point Average (GPA)9.- MCAT Score10.- Name & address of parent(s) or legal guardian(s): Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home phone of parents or legal guardiansHispanic/Latin Background11.- Name and city of high school(s) attended: 12.- List the name of any college(s) you have attended13.- What specialty/fellowship do you plan to accomplish as you continue your post medical school education?14.- List expenses you expect to incur in 2020-2021 per semester or quarter15.- List other financial assistance you will receive per semester or quarter16.- What are your educational and professional goals and objectives?17.- List your academic honors, awards and membership activities while in high school, college or medical school:18.- List your community service activities, hobbies, outside interests, and extracurricular activities:19.- Personal Essay Please answer the following question: How have you worked in your life to make a positive difference?20.- The following items below along with a brief Personal Letter must be attached to this application in order for the application to qualify to be reviewed by the scholarship committee.*Two (2) recommendation letters*Proof of medical school/college acceptance or current student enrollment*Direct from your school, a Summary Profile Sheet and Record of College Work*Personal Essay.Upload Documents