I certify that all of the information submitted with my application is true and complete to the best of my knowledge. If asked by an authorized official of the Sierra Foothills Medical Society, I agree to provide proof of the information I have given. I understand that the inclusion of any false or misleading information will result in the rejection of my application or the return of any financial aid I do receive. Permission is hereby given to school, federal, state and/or county officials to release to the Sierra Foothills Medical Society any information concerning my financial aid and academic circumstances necessary to my application for a grant from the Sierra Foothills Medical Society Medical Student Scholarship Fund. I also agree to permit the Sierra Foothills Medical Society to share the information I have provided with any of the references I have listed. Furthermore, I have read the application instructions, and I am aware that an incomplete application will not be processed.