Resident Scholarship Application

Please have the following supplemental materials to upload.

1. Written Narrative
   Each applicant is required to submit a narrative addressing:
1. Why I chose to be a physician
2. Your community project (see examples below)
2. Residency Community Project Grant: Describe your Project with the following guidelines:
1. Improve community Health Literacy and patient advocacy
2. Increase the use of telemedicine for community medical practices
3. Improve physician participation in the Accountable Communities of Health
4. Address community and health care priority for public health
5. Strengthen the doctor-patient relationship in health care delivery
6. Review the needs and opportunities for charitable care.
7. Define the health care needs of the non-citizen component of our population
3. Faculty Reference
   Please have your program director or faculty advisor complete the following reference form and scan/email, fax or mail it directly to SCMS

"*" indicates required fields

General Information

Name

First Last Credentials (MD, DO, etc.)

Address you can be reached at:

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Email Address*

Name of residency program you are attending:

I hereby declare that to the best of my knowledge, the above information is correct and complete.*

Please enter your signature.

Uploads

Please have the following supplemental materials to upload.

1. Written Narrative
   Each applicant is required to submit a narrative addressing:
1. Why I chose to be a physician
2. Your community project (see examples below)
2. Residency Community Project Grant: Describe your Project with the following guidelines:
1. Improve community Health Literacy and patient advocacy
2. Increase the use of telemedicine for community medical practices
3. Improve physician participation in the Accountable Communities of Health
4. Address community and health care priority for public health
5. Strengthen the doctor-patient relationship in health care delivery
6. Review the needs and opportunities for charitable care.
7. Define the health care needs of the non-citizen component of our population
3. Faculty Reference
   Please have your program director or faculty advisor complete the following reference form and scan/email, fax or mail it directly to SCMS

Essay

Accepted file types: pdf, doc, docx, Max. file size: 256 MB.

Signed Faculty Form

Accepted file types: pdf, Max. file size: 256 MB.

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