General Scholarship: Application - Wisconsin Medical Society

Foundation General Scholarship Application
Note: You can save your application and continue later at the bottom of the page. However, all required fields need a drafted response.

Learn more about Foundation scholarships here.
Are you currently enrolled and will you continue to be enrolled full-time in the next academic year beginning after July?*

YesNo
Do you wish to practice in Wisconsin when you complete your training?*

YesNoUnsure
Are you a student member of the Wisconsin Medical Society?*

YesNo
What is your anticipated year of graduation?*
What is your Student ID for financial aid at your school*
This is the number that is used to tie your scholarship to your own financial aid packet. It is not a social security number or FAFSA School ID.
Full-time enrollment and affiliations in the next academic year. (Check all that apply.)*

UW School of Medicine and Public HealthMCW-MilwaukeeMCW-Green BayMCW-Central WIUW-Madison School of NursingI am from Racine or Milwaukee County enrolled in a medical technology or clinical lab science program.I am a member of a recognized American Indian Tribe and/or I identify as American Indian and have been and have demonstrated a commitment to American Indian health and equity. I am enrolled in a medical or health science program.None of the above categories apply. At this time, I do not qualify for a Foundation Scholarship.
Name of School:
Financial aid office of your school:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Section Two: Background Information
Name*

First NameMiddle NameLast Name
Preferred Name
How would you like to be addressed in correspondence
Pronouns*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Email*

Confirmation EmailA copy of your responses will be sent to this address.
Non-school Email*

Confirmation Email
Phone Number

Area CodePhone Number
If you graduated from high school in Wisconsin, from which Wisconsin County did you attend high school?*
Number of dependents under the age of 18*
Please enter a number from 0 to 20.
What is your total school debt; including undergraduate and student loans?*
What is your total unmet financial need for next year?*
This number should include all expected out-of-pocket expenses and all loans you plan to take out.
Are you the first person in your family to obtain a bachelors degree or higher?*

YesNo
Award Determination: This section helps to determine which named scholarships you will be considered for. If you answer "yes" to any of the questions below, please explain in your personal narrative. Select all that apply.

Victor A. Baylon Scholarship: Are you from Racine or Milwaukee County and pursing a medical degree or a degree in medical technology or clinical lab sciences?Future Superhero of Medicine Scholarship: I am enrolled full time and pursuing a degree in Medicine or health sciences and I am Black, Latinx or another underrepresented minority.Goodman-Goodell Scholarship: Are you an M2 with ties to the Portage area and do you have an interest in pulmonology or general family practice?Robert Jason Gore Scholarship: Have you had life experiences that exemplify chivalry, honor and loyalty? A preference will be given to veterans and those with ties to the Sheboygan area.Amy Hunter-Wilson, MD, Scholarship: Are you an American Indian and are you currently enrolled in training or advanced education as a doctor of medicine, nurse, or in a related health field and do you expect to be in the next school year.Barron, Washburn, Burnett County Medical Society Award: I am a medical student in Wisconsin and I graduated from high school in Barron, Washburn, or Burnett County.Jefferson County Medical Society Scholarship: Did you graduate from high school in Jefferson County Wisconsin and are you currently enrolled and actively taking courses in medical school in Wisconsin and will you will be enrolled and taking courses in a Wisconsin medical school in the next school year?Marathon County Medical Society Scholarship: Are you from Marathon County and will you be entering your last or next to last year of medical school?John D. and Virginia Riesch Scholarship: I am a student enrolled at UW School of Medicine and Public Health or UW Madison School of Nursing pursuing a career as a physician or nurse. I demonstrate empathy, recognition of colleagues, passion for learning and the desire to share your knowledge to educate colleagues and patients. I desire to practice in Wisconsin.Rukmini and Joyce Vasudevan Scholarship: Are you a female identified student who will be entering your last or next to last year of medical school who has overcome unusual or significant adversity or obstacles in life?Edmund J. and Estelle D. Walker and General Medical Education Scholarships: Are you currently enrolled and actively taking courses in medical school in Wisconsin and will you will be enrolled and taking courses in a Wisconsin medical school in the next school year.Presidential Scholar Award: I am entering my final real of medical school and am actively involved with the Wisconsin Medical Society, AMA or county medical society. Preference is given to students from Wisconsin who wish to practice in Wisconsin. You must have a letter of recommendation from a Wisconsin Medical Society member or County Medical Society officer who has worked with during your involvement.
List the major or specialty you are considering:*
List any Wisconsin Medical Society committees you have participated in or have been a member of:
For the Presidential Scholar Award only - Please affirm the following:

I am entering my final year of medical school next fall.I plan to practice in Wisconsin.I am actively involved with the Wisconsin Medical Society, AMA or a county medical society.My reference is from a Wisconsin Medical Society member or County Medical Society officer who has worked with me on the Wisconsin Medical Society Board, a Wisconsin Medical Society council, taskforce or committee, or on a County Medical Society board, council, taskforce or committee.
Personal Statement

In the text box provided below, please type or cut and paste your personal statement. Your personal statement is an important aspect of the application and is the equivalent of an interview. Please make sure you address the following:

Brief family background; achievements; current higher education status; career goals including practice type(s) of most interest (specialty, primary care, urban, rural, academic, etc.); financial need for this scholarship; examples of your leadership including with the Wisconsin Medical Society, AMA, your county medical society or your school; examples of your volunteerism; unusual circumstances; any other information relevant to this application.
Personal Statement:*

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Certification: By checking this box I certify all of the information provided is complete and accurate to the best of my knowledge. I hereby give the Wisconsin Medical Society Foundation Scholarship Selection Committee permission to share this information, with the exception of my financial information, for the purpose of recruitment and public relations. I further certify that I am currently enrolled in a medical school or in a nursing or related health career program at an accredited college or university for the upcoming academic year, and will use the Foundation scholarship award toward expenses related to my education. Falsification of information may result in termination of any scholarship granted. All application materials become the property of the Wisconsin Medical Society Foundation.*

Certification
Please verify that you are human*
Would you like to save and continue later? After clicking Submit, a link to your responses will appear on the screen and be emailed to your school email. Save this link to continue your responses later. Note: all required questions must have a drafted response before clicking Submit.*

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At this time all Wisconsin Medical Society Foundation Awards can only be made to students currently enrolled full time as well as in the next academic year. If you have questions, please contact Jaime Craig. We wish you all the best in your career. Thank you.
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Foundation General Scholarship Application