GMSF Scholar. - MCAT/DAT - Greensboro Medical Society

If you have any questions or concerns, please contact us.
336-517-7230 - phone
[email protected]

Due Friday, January 31, 2025 11:59 pm

Medical / Dental Preparation Scholarship Application Details

* Indicates required field

Name of Test Prep Applicant *

First

Last

Date of Birth *

Gender *

Male Female

City / State of Birth *

Email *

Phone Number *

US Citizenship *

Yes No

Upload Photo *

Max file size: 20MB

Mailing AddressMailing Address For Check Distribution *

Line 1

Line 2

City

State

Zip Code

Country

Planned year of application to medical/dental school (ex. Fall 20xx or Spring 20xx) *

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 *

Educational History:College or University level (List current or most recent first).

Institution 1 *

City / State *

Degree *

Dates Attended (Month and Year) *

Field of Study *

GPA *

List Pre-Med / Dental Courses Completed *

Institution 2 *

City / State *

Degree *

Dates Attended (Month and Year) *

GPA *

List Pre-Med / Dental Courses Completed *

High School (Name and Location) *

Degree *

Employment History

Name of employer and address (List current or most recent first):

Employer 1 *

Job Title and Type of Work *

Employment Dates (Start and Finish) *

Employer 2 *

Job Title and Type of Work *

Employment Dates (Start and Finish) *

Extracurricular Activities *

Leadership positions in college *

Personal Reference of two individuals not related to you who we may contact

Name 1 *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Name 2 *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Demographic Information

Number of Siblings *

Mother’s name, occupation and current place of employment *

Father’s name, occupation and current place of employment *

Tell us why you want to pursue a health career (less than 500 words)- *

Name *

First

Last

Submit

​Greensboro Medical Society

Medical / Dental Preparation Scholarship Application Details

Greensboro Medical Society