Lorain County Medical Scholarship Application Form
Please fill out your details and upload any required documents.
Full Name
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First Name
Last Name
Age
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Gender
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Home Address
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Email Address
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Marital Status
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Number of Dependents
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Date of residence in Lorain County began?
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Date of residence in Lorain County ended?
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Name of the high school or college you last attended?
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Date of graduation from high school?
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Date of graduation from undergraduate program?
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Name of college or university you are currently attending?
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Name of the college or university for which you are requesting the scholarship?
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Address for the college or university for which you are requesting the scholarship?
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Course of study?
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Date of acceptance into course of study?
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Status for fall?
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GPA to date?
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Tuition per year?
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Fees per year?
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Room and board per year?
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Total actual cost per year?
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Parents contribution?
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Applicant's summer income?
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Spouse's contribution?
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Total funds available?
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Have you previously applied to the Lorain County Medical Society Foundation for a scholarship?
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Years applied for funding?
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Have you previously received a Lorain County Medical Society Foundation scholarship?
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Scholarship amount received?
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Briefly describe what you are doing to help finance your education (both during the school year and during the summer):
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List any previous work experience:
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Current employer name and address?
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Briefly explain your reasons for choosing your profession and state your long-term goals and plans after graduation:
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Have you applied for other scholarships/loans/or financial aid for this coming school year?
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List the names and amounts received for these additional scholarships/loans:
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Any academic achievements you would like to share?
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Upload all supporting documentation here:
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I confirm that all information in this application is true and correct to the best of my knowledge:
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IMPORTANT: Scholarship interviews will be held in 10-minute intervals via Zoom on Tuesday, June 9th, 2026.
Before submitting your application, please click the link below to select a time to meet with the scholarship committee. If you have any questions, please contact the administrator, Erin Lesueur: erin@lcmedicalsociety.com
Sign up for your interview here:
https://www.signupgenius.com/go/10C084EAFAA2AA7FEC43-63937028-2026
Submit Application
Submit Application
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