Kelly Family Endowment Leadership Scholarship Application
Financial support for the everyday needs of emerging orthopedic surgeons. The Kelly Family Endowment’s Leadership Scholarship was conceived to develop leadership skills for those younger AANA members who by virtue of race, gender, health or financial situation, have experienced unusual hardship in their journey in becoming an orthopedic surgeon. The Scholarship is in honor of Michael P. Kelly, Sr, noted civil rights attorney and champion of the underserved. The endowment’s chief aim is to prepare and equip future leaders to help both navigate and transform the current culture of Orthopedic Surgery which poorly represents women, minorities and the impoverished.
Section 1 - Applicant Information
Basic details about you and your current training position.
First Name
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Last Name
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Email Address
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example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
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Month
-
Day
Year
Date
Current Institution / Hospital
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Training Level
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Please Select
PGY-3 Resident
PGY-4 Resident
PGY-5 Chief Resident
Fellowship
Early Practice
Subspecialty Interest
Please Select
Sports Medicine
Sports Medicine — Shoulder
Sports Medicine — Knee
Sports Medicine — Hip
Sports Medicine — Foot & Ankle
Other
Section 2 - Background & CV
Upload your CV / curriculum vitae
*
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of
Medical school & graduation year
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Undergraduate institution
Notable achievements & publications
Section 3 — Personal Statement
Share your story, goals, and how this scholarship will supportyour development as an orthopedic surgeon.
What extraordinary challenges have you faced in your formation of becoming an Orthopedic Surgeon?
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Describe your financial situation and why this award would make a meaningful difference to your training…
Your vision for leading change in orthopedic surgery and addressing current inequities resulting from race, gender or financial hardship.
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Where do you see yourself in 10 years? What change do you hope to bring to the field?
How will you pay it forward?
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Describe how you plan to give back — mentorship, community service, advocacy, or other contributions…
Section 4 — References
Reference 1 — Primary (required)
Full Name
*
First Name
Last Name
Title / Role
Institution
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Applicant
Upload Reference Letter
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of
Reference 2 — Secondary (optional)
Full Name
*
First Name
Last Name
Title / Role
Institution
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Applicant
Upload Reference Letter
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Section 5 — Review & Submit
Before submitting, please review your entries and confirm the declarations below.
Declarations
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I certify that all information provided in this application is true and accurate to the best of my knowledge.
I understand that submitting false or misleading information will result in immediate disqualification.
I consent to the use of my application data for scholarship evaluation purposes only.
I agree to provide proof of enrollment upon request.
I acknowledge that the scholarship committee's decision is final and binding.
Applicant Signature
*
Date
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Month
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Day
Year
Date
Submit Application
Submit Application
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