Student Loan Application - Wisconsin Medical Society

Note: At the bottom of this page you are able to save your application and continue it later. All required questions must have drafted responses.

Mission
The mission of the Wisconsin Medical Society Foundation is to advance the health of the people of Wisconsin by supporting medical and health education.

Purpose
The Wisconsin Medical Society Foundation Student Loan Program is designed to address a portion of the unmet need in a medical student’s budget after aid has been received from other sources. Awards are limited to $10,000 per year for a maximum of three years or $30,000. Students entering their first year of medical school are not eligible.

Applications must be submitted annually to the financial aid office where the medical student is enrolled. Wisconsin Medical Society Foundation staff will notify loan recipients of approval no later than April 15. All loan proceeds are paid directly to the school in two equal installments.

Loans from the Wisconsin Medical Society Foundation Student Loan Program, which encompasses all loan funds administered by the Foundation, shall be operated under the following rules and regulations effective November 1, 2022:

Application and Solicitation Disclosure Form

Do you reside in the state of Wisconsin as deemed by the Higher Education Aids Board of the State of Wisconsin?*

YesNo

Are you enrolled on a full-time basis and in good standing at:*

What is your expected year of graduation?*

What is your school ID number:*

Will you be enrolled at the indicated medical school on a full-time basis in the next academic year?*

YesNo

Are you a student member of the Wisconsin Medical Society or eligible to become a member (if not on an approved leave of absence)? If you're unsure of your membership status, please contact Jaime Craig at jaime.craig@wismed.org.*

YesNo

Do you plan to borrow more than $20,000 in Federal Direct Student Loans for the next school year?*

YesNo

Do you meet the eligibility requirements of the Federal Student Aid program?*

YesNo

Click here to view Federal Student Aid eligibility requirements.

Are you in default on any educational loan, have you shown an unwillingness to repay any educational loan, or do you owe any refund on a grant or loan?*

YesNo

Click here to view your National Student Loan Data System (NSLDS) Financial Aid Review.

Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is this your permanent home address?*

YesNo

Permanent address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email (non school)*

Confirmation EmailA copy of your responses will be sent to this address.

School Email*

example@example.com

Phone Number*

Area CodePhone Number

Date of Birth*

Date

County in which you graduated high school:*

Marital status*

What is your spouse's name?

First NameMiddle NameLast Name

How many dependents under the age of 18 are in your household?*

Name of parent or close family member*

First NameLast Name

Address of parent or close family member*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What is your total debt including all outstanding student loans for both undergraduate and graduate school including Federal Direct, Unsubsidized, Perkins, Grad Plus Loans, School Loans, previous Wisconsin Medical Society Foundation Loans or other private lender loans?*

List of the specialty or specialties you are considering:*

Biographical Narrative*

Please compose a brief personal statement. Please be sure to address the following: Professional goals, your need for financial aid, participation in programs targeted toward working with under-served populations or in areas of need, your leadership and community service activities, and any unusual circumstances that should be taken into consideration.

To apply for this loan you must complete the Private Loan Application Self-Certification Form (certification form) and Student Request for Release of Financial Aid Information Form (release form). You will receive instructions on how to complete a certification form and release form in an email you will receive after submitting this application.

Terms of Loan and General Information

Third Party Authorization*

I also hereby authorize the Wisconsin Medical Society Foundation (“Foundation”) to release any information related to my application for; award, servicing and repayment of; or otherwise related to this loan, and for no other purpose, including but not limited to information in this application, to University Accounting Services (UAS) and any other individual or entity as necessary to evaluate, administer or service this loan unless or until such authorization is revoked by me in writing.

Certification*

By checking this box, I certify that all the information I have provided on this application form is accurate and complete, and that if I am granted assistance, I will use the funds only for education purposes as defined as tuition, room, board, fees, books, supplies and equipment.

Thank you for your interest in the Wisconsin Medical Society Foundation Student Loan Program. At this time you are not eligible for a Foundation student loan. We wish you all the best in your career path.

Would you like to save and continue later? After clicking Submit, a link to your responses will appear on the screen. Save this link to continue your responses later. Note: all required questions must have a drafted response before clicking Submit.*

Save responses and continue laterSubmit application now

Please verify that you are human*

2023 - 2024 Student Loan Application

Section One: Eligibility

Section Two: Demographics

Section Three: Certification