Drs. David and Yolando Chatman Scholarship Application
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Medical School
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Current Year
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Expected Date of Graduation
*
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What is your ethnicity?
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African or African American
American Indian or Alaskan Native
Asian
Caucasian
Hispanic, Latino or Spanish Heritage
Native Hawaiian or Pacific Islander
Multiracial / Multicultural
Prefer not to answer
What is your gender?
*
Female
Male
Non-binary / Other
Prefer not to answer
Are you a member of the LGBTQIA+ Community?
*
Yes
No
Prefer not to answer
Are you an Active-Duty Member or Veteran of the U.S. Military?
*
Yes
No
Prefer not to answer
Do you have a disability?
*
Yes
No
Prefer not to answer
Are you a first-generation college student?
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Yes
No
Prefer not to answer
Do you have any socioeconomic barriers?
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Yes
No
Prefer not to answer
What is your current GPA?
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≥ 4.0
3.5 to 3.9
3.0 to 3.4
≤ 3.0
Prefer not to answer
Are you considering pursuing a career in primary care?
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Yes
No
Uncertain
Are you considering pursuing a career to serve underrepresented communities?
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Yes
No
Uncertain
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Personal Statement
Tell us about your journey to a career in medicine and how this scholarship will support your personal goals.
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Underrepresented in Medicine
It is the objective of Murfreesboro Medical Clinic to support students who may be underrepresented in medicine through this scholarship program. Please tell us any diverse or unique life experiences, identities, or point of view that you have noticed you bring to your medical school student body.
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Leadership and Service
Please describe any school or community leadership, service, employment, or activism that you are involved in and the way you anticipate this experience informing your future practice of medicine.
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Investment in Tennessee
Please note this is only one of many factors that contribute to applicant selection.
One of our goals with this scholarship is to invest in students who see themselves serving the population of Middle Tennessee in a longer-term way. Please tell us about any ties to the state or to the southeast you may have and any plans you may foresee to practice locally.
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Interest in Elective or Shadowing Opportunities
Would you be interested in rotating with the physicians at Murfreesboro Medical Clinic as part of a medical school elective or shadowing opportunity? Please note this is not required for scholarship eligibility/award, but will help our group reach out to applicants who many be interested/eligible in this possible opportunity. Please note specialty interest and availability.
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Socioeconomic Considerations
Expenses (Previous Year)
Tuition
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Cost of Living
*
Official estimate from your medical school's Office of Financial Aid
Additional Significant Expense
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Additional Significant Expense
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Additional Significant Expense
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TOTAL Annual Expenses
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Socioeconomic Considerations
Resources (Previous Year)
Total Income
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Parental Assistance
*
Financial Aid / Scholarships
*
TOTAL Annual Resources
*
Average Annual Loans
*
TOTAL Student Loan Debt
*
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Socioeconomic Considerations
Discuss any relevant factors you would like us to consider with regard to your financial records.
*
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Agreement
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