GMSF Scholar. Appli

If you have any questions or concerns, please contact us.
336-517-7230 - phone
contact@greensboromedicalsociety.com
Due Monday, January 16, 2023, 11:59pm

Scholarship Application Details

* Indicates required field

Name of Medical Scholar 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 Address For Check Distribution *

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 *

Institution 2 *

Institution 3 *

Have you been accepted to an institution by the time of this application *

Yes No

Institution *

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 *

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 at Institution 1 *

Institution 2 *

City / State *

Degree *

GPA at Institution 2 *

Dates Attended (Month and Year) *

High School (Name and Location) *

Degree *

GPA at High School *

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)- *

Submit

​Greensboro Medical Society

Scholarship Application Details

Greensboro Medical Society