Community Services
 

Scholarship Fund  -  Application Form

The Scholarship Committee awards scholarships to medical students each year.  The number and amounts offered are evaluated each year based on the monies available through donations and fund raising.  The Committee is currently accepting applications for 2013.

The criteria for scholarship awards will be based on scholastic achievement, financial need and community service.  The applicant must be a legal resident of Central Massachusetts at the time of applying to medical school and currently attending an accredited medical or osteopathic school.  He/She must submit a current transcript, two letters of recommendation, and an essay stating the applicant’s reasons for selecting a career in medicine and why they feel deserving of the award.

Application deadline is July 26, 2013.  Only completed applications will be considered. Applications received after the deadline will not be accepted.

Eligibility:

2nd, 3rd, 4th year students enrolled, (with a tuition obligation) in an accredited medical or osteopathic school and a legal resident of Central Massachusetts at the time of applying to medical school.

Criteria:

Students in high academic standing who demonstrate involvement in community service and have a financial need.
Note: Financial aid offices in all accredited medical schools deduct the award amount from the loan amount available.

Process:

Students may request a scholarship application and packet beginning June 1st interviews are conducted during the months of August and September. Candidates will be notified by September 30, 2013.

Applications:

The following materials are required for application:

  1. Completed application form

  2. Current transcript

  3. Two letters of recommendation (preferred) if reapplying please include current letters of recommendations.

  4. Essay stating applicant’s reasons for selecting a career in medicine, and why they feel deserving of the award.

The Scholarship Committee will review the candidates’ applications and make a selection based on academic performance, community service and financial need.

Telephone interviews may be conducted.  Candidates should be prepared to discuss their involvement with community service.  Personal interviews may be required.

Length of Funding:

Yearly – renewable upon request

Application Information:

Applications may be submitted using the online form below or downloading the PDF file provided.
*Cities and Towns in Central Massachusetts
 
Ashburnham E. Brookfield Leominster Pepperell Townsend
Ashby Farnumsville Linwood Petersham Upton
Athol Fisherville Lunenburg Phillipston Uxbridge
Auburn Fiskdale Marlboro Princeton W. Auburn
Ayer Fitchburg Mendon Rochdale W. Boylston
Barre Gardner Milford Royalston W. Brookfield
Bellingham Gilbertville Millbury Rutland W. Upton
Berlin Grafton Millville S. Lancaster W. Warren
Blackstone Groton N. Brookfield Shirley Warren
Bolton Hardwick N. Grafton Shrewsbury Webster
Boxboro Harvard N. Oxford South Barre Westboro
Boylston Holden N. Spencer Southboro Westborough
Brimfield Hopedale New Braintree Southbridge Westminster
Brookfield Hopkinton Northborough Spencer Whitinsville
Charlton Hubbardston Northbridge Sterling Winchedon
Clinton Hudson Oakham Sturbridge Worcester
Douglas Lancaster Oxford Sutton  
Dudley Leicester Paxton Templeton  

*Resources: Worcester District Medical Society Bylaws.  Worcester Chamber of Commerce.

Scholarship Application

*Required

Part I:  Applicant Information

1.

*Last Name:

  
  *First Name:  
  Middle or Maiden:
 

2a.

 Institution:
  Address:
  City:
  State:
  Zip:
 

2b.

 Legal Address:
  City:
  State:
  Zip:
  Daytime Phone:
   

2c.

 Please provide us with your address at the time of your application to medical school
  Address:
  City:
  State:
  Zip:
 

3.

 Expected Date of Graduation: (mm/dd/yyyy)
 

4.

 Member of MA Medical Society / Worcester District Medical Society? 
 

Part II:  Education

5.

List in reverse chronological order, all colleges, universities, and professional schools attended (most recent first)

Major &
Minor Fields		 Dates of
Attendance		 Degree Received
or Pending Year		 Name / Address
of Institution
 

 
 
 

Part III:  Experience

6.

List below the professional employment you have held, starting with most recent

Institution Dates Nature of Duties
 

 
 
 

Part IV:  Academic Achievements

7.

Please list honors, grants, publications, special projects.
 

 

8.

Please describe any special or personal circumstances which you believe should be considered to better understand your financial need.
 

   
9. *Current Educational  Debt:
  $     
   

10.

References:
Please list three references with phone numbers who could be contacted by the committee.
 

 
 
   
  The information supplied by me on this application is true and correct to the best of my knowledge, and I understand that misrepresentation may cause denial or withdrawal of the scholarship.
 

*Email Address:
 

Telephone where you can be reached for an interview:
 

The best dates & times to reach me are: (please list three choices)
 
 
 

Download the Scholarship Application Form


Click to download a copy of Adobe Acrobat Reader...

 
 

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