Greensboro Medical Society
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Scholarship GALA
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Home
GMS Serves
Scholarship GALA
Store
Contact Us
If you have any questions or concerns, please contact us.
336-517-7230 - phone
contact@greensboromedicalsociety.com
Due
Sunday Jan. 14, 2024,
11:59 pm
Scholarship Application Details
*
Indicates required field
Name of Medical Scholar Applicant
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First
Last
[object Object]
Date of Birth
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Gender
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Male
Female
City / State of Birth
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Email
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Phone Number
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US Citizenship
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Yes
No
Upload Photo
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Max file size: 20MB
Mailing Address For Check Distribution
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Line 1
Line 2
City
State
Zip Code
Country
Name of Institution you plan to attend and its location (If you have been accepted and are undecided list your top choices--limit 3):
Institution 1
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Institution 2
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Institution 3
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Have you been accepted to an institution by the time of this application
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Yes
No
Institution
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Attach letter of acceptance. Proof of matriculation will be required before scholarship awards are issued
*
Max file size: 20MB
How did you find out about The Greensboro Medical Society Foundation Scholarship program? If a Society doctor referred you, please indicate his/her name and relationship
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Educational History:College or University level (List current or most recent first).
Institution 1
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City / State
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Degree
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Dates Attended (Month and Year)
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Field of Study
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GPA at Institution 1
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Institution 2
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City / State
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Degree
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GPA at Institution 2
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Dates Attended (Month and Year)
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High School (Name and Location)
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Degree
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GPA at High School
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Employment History
Name of employer and address (List current or most recent first):
Employer 1
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Job Title and Type of Work
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Employment Dates (Start and Finish)
*
Employer 2
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Job Title and Type of Work
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Employment Dates (Start and Finish)
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Extracurricular Activities
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Leadership positions in college
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Personal Reference of two individuals not related to you who we may contact
Name 1
*
Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
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Phone Number
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Name 2
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First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Phone Number
*
Demographic Information
Number of Siblings
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Mother’s name, occupation and current place of employment
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Father’s name, occupation and current place of employment
*
Tell us why you want to pursue a health career (less than 500 words)-
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Submit