YHM Scholarship application

You have matched Scholarship Application Form

Application Deadline - March 1st, 2024
Read and follow the instructions carefully before submitting your application. All winners will be notified on or before March 11th 2024.
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender

MaleFemaleNon-binaryOther
II. Educational Background
High School Attended*
What university did you attend or are currently attending?*
Are you a first generation college student?*

Yes, I am the first among my parents or grandparents to attend college.No, either my parents or grandparents have attended college.
Which option best describes your Education status.*

I am in medical schoolI have graduated and am doing my SERUMSI am a fully licensed physicianI have graduated medicine and am studying for the USMLE Step exams
Why did you choose a profession in healthcare?*

0/300
How do you envision using your medical education to make a positive impact on your community?*

0/300
II. Volunteer Experience
Have you travelled with Selva in Action in the past?*

YesNo
Are you or will you be able to travel in 2024? Please confirm with your school/work schedule availability for May 4th-May 10th 2024.*

YesNo
Describe any community service or volunteer experience related to healthcare.*
How did this experience influence your perspective on healthcare and community well-being?*
III. Future Goals
Do you have specific career goals within the field of medicine?*
Do you have any desire to practice medicine in the United States? If so, what steps are you taking towards this?*
Note: If you have taken any of the steps please share your experience as well as current test dates.
VI. Extras
Have you ever received a scholarship at your school?*

YesNo
Were you born outside of Peru?*

YesNo
If so, which country?*
In addition to a scholarship, would you like to be considered for future research opportunities?*

YesNo
VII. Essay
Your essay should be 300-500 words. You should address in your essay: What you expect to obtain from your experience at Selva in Action and how you can use what you have learned to help your community.
Essay*

0/500
VIII. Applicant's E-Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature*

Clear
You Have Matched The Podcast is committed to equal opportunity in employment and education. The College does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
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You have matched Scholarship Application Form

I. Personal Data

II. Educational Background

II. Volunteer Experience

III. Future Goals

VI. Extras

VII. Essay

VIII. Applicant's E-Signature