Pamies Scholarship Fund Application
2019
Name
*
Prefix
First Name
Middle Name
Last Name
Suffix
School E-mail
*
Personal Email
example@example.com
Phone Number
-
Area Code
Phone Number
Current Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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Other
Country
Are you a first-generation college student
Yes
No
FAFSA EFC
Enter Amount
Which of the program's iteration did you attend?
*
MMEP
SMEP
SMDEP
SHPEP
What year did you attend the program?
*
What was the name of the program site you attended?
*
Name of College/Institution
What is your career pathway (i.e. Medicine, Dentistry, Nursing, Pharmacy, etc.)?
You may include more than one in your response.
The scholarship aims to provide financial assistance to alumni who demonstrate a commitment to eliminating health disparities by providing patient-centered and culturally-sensitive health care. Describe how your work has supported these goals and makes you a good candidate for the scholarship award?
*
250 word limit
0/250
Briefly describe your short and long-term career goals, with an emphasis on how you envision yourself working to bring about health parity within your field of practice.
*
250 word limit
0/250
Describe how this scholarship award may contribute to your application and/or testing needs as you pursue a career in the health professions? If applicable, please describe any personal circumstances that may influence your need for financial assistance.
*
250 word limit
0/250
List any academic honors, awards and/or community service activities that further highlight your passion for healthcare equity and the importance of diversity in the health professions.
250 word limit
0/250
Submit
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