PACEP DEI Scholarship Application 2025

PACEP DEI Scholarship Application 2025

Deadline for applications is January 8, 2025
The PACEP Diversity, Equity, and Inclusion Task Force is pleased to present the following scholarship application to increase diversity in our Emergency Physician pipeline by supporting medical students in their pursuit of away rotations to Pennsylvania emergency medicine residency programs.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Medical School*
Medical School Year*
Please tell us why you are seeking this scholarship.*
What drives your passion for Emergency Medicine? (250-350 word count)*

0/350
Do you already have your away rotation confirmed?*

YesNo
If the answer to the question above is YES, please upload confirmation/approval of the rotation.

Cancelof
If the answer to the above question is NO, please tell us where you are in the planning stage of your rotation.

Cancelof
Please upload your CV.*

Cancelof
Should be Empty: