Dr. William and Nancy Lascheid Memorial Scholarship Application (2026)

The scholarship offered by the Foundation of Collier County Medical Society honors and remembers Neighborhood Health Clinic co-founders Dr. William and Nancy Lascheid and their legacy of providing care and a medical home for thousands of underserved in Collier County. Eligible Florida residents* enrolled in or accepted to medical/osteopathic school, who have demonstrated excellence in service to their community, may apply. Recipients are selected by the Foundation upon review of the application and supporting materials. The dollar amount of scholarship(s) may vary dependent upon available Foundation funds.
*Must be a bona fide resident of Florida for at least 12 months prior to enrollment in medical program (not including time spent attending an undergraduate/graduate school in Florida).

The entire application must include:

Completed application form
Personal statement from the applicant reflecting on participation in community service efforts, motivation for becoming a physician, and what applicant hopes to accomplish in the medical field (max. 800 words)
Letter of recommendation from a faculty member
Letter of recommendation from a community service provider
MD/DO school transcript OR final transcript from pre-medical study plus letter of acceptance from MD/DO school (copy or unofficial transcript acceptable)

Personal Information

Applicant's Name:*

Medical School Name:*

Current Home Address:*

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Cell Phone:*

Email Address:*

example@example.com

Date of Birth:*

Date

Permanent Resident of Florida:*

YesNo

Education

High School

School Name:*

Location (city, state):*

Year graduated:*

GPA:*

SAT Score - Verbal:

SAT Score - Math:

ACT Scores:

Class Rank:*

Percentile %:*

Class Size:*

Academic Honors, Athletic & Extracurricular Activities, Clubs, Offices Held, Research Projects, Publications:

Undergraduate School

Name of College:*

Location (city/state):*

Year Graduated:*

Degree:*

Major/Minor:*

GPA:*

Academic Honors, Athletic & Extracurricular Activities, Clubs, Offices Held, Research Projects, Publications:

Graduate School

Name of College:

Location (city/state):

Year Graduated:

Degree:

Major:

GPA:

Academic Honors, Athletic & Extracurricular Activities, Clubs, Offices Held, Research Projects, Publications:

Medical School

Status:*

Enrolled inAccepted to

School Name:*

Location (city/state):*

Expected Grad. Year:*

Degree:*

Student ID:

GPA:

Academic Honors, Athletic & Extracurricular Activities, Clubs, Offices Held, Research Projects, Publications:

Other / Additional Medical School Acceptance

School Name:

Location (city/state):

Year Graduated/Expected:

Degree:

Major:

GPA:

Academic Honors, Athletic & Extracurricular Activities, Clubs, Offices Held, Research Projects, Publications:

Community Service/Volunteer Work

Organization:*

Location (city/state):*

Start Date:*

Date

End Date:

Date

Approximate Number of Hours Contributed:*

Description of work provided:*

Organization:

Location (city/state):

Start Date:

Date

End Date:

Date

Approximate Number of Hours Contributed:

Description of work provided:

Organization:

Location (city/state):

Start Date:

Date

End Date:

Date

Approximate Number of Hours Contributed:

Description of work provided:

Student Financial Statement

Employment Status:

Full timePart timeSeasonalNone

Employer/Location:

Start Date:

Date

Position:

Wage:

Marital Status:

MarriedDivorced/SeparatedSingleOther

Spouse/Partner Occupation:

Number of Dependents:

Was student listed as an exemption on parents’ income tax return last year?

YesNo

Tuition Expense: $

Living Expense: $

Earned Income: $

Gifts and/or Grants: $

Current pre-medical debt: $

Current medical school debt: $

Total debt to date: $

Projected debt at graduation: $

Please describe how the applicant’s spouse/partner, parent(s), and/or family members will assist in the costs of the applicant’s medical education:

Please describe any extenuating circumstances that demonstrate financial need:

Signature of Applicant (type your full legal name):*

Date:*

Attachments

Personal Statement (max 800 words)*

Browse Files

Letter of Recommendation from faculty member*

Browse Files

Letter of Recommendation from a community service provider*

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MD/DO school transcript (copy or unofficial transcript acceptable), or final transcript from pre-medical study*

Browse Files

If submitting final transcript from pre-medical study, upload a letter from MD/DO school on letterhead verifying acceptance

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CV/Resume or additional documentation, if desired

Browse Files

Deadline: Applications must be submitted by March 31, 2026.

Questions: Contact Foundation of CCMS at info@ccmsonline.org or 239-435-7727.

The Foundation of Collier County Medical Society, Inc. is a 501(c) (3) organization, State of Florida Registration No. CH38165. Tax ID No. 46-1391700
A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE 1-800-435-7352. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE

The Dr. William and Nancy Lascheid Memorial Scholarship for Medical Students 2026 Application