The Aroostook County Medical Society Scholarship Fund Application - Daniel Hanley Center for Healthcare Leadership

The Aroostook County Medical Society Scholarship Fund

The Aroostook County Medical Society (ACMS) disbanded several years ago, and they granted their remaining funds to the Hanley Center Scholarship Fund to provide grant support for students from Aroostook County who are enrolled in an accredited medical school. Scholarship up to $1,000 per student per year will be awarded until all funds are expended. The application period is now closed.

Applicant Information

First name(Required)

Last name(Required)

SSN #

Date of birth(Required)

Place of birth(Required)

Please explain your connection to Aroostook County (if NOT by birth or current legal address).

Mailing Address

Mailing Address(Required)

Mailing Address line 2

Mailing City(Required)

Mailing zip code(Required)

Mailing address state(Required)

Legal Address

Legal Address(Required)

Legal Address line 2

Legal City(Required)

Legal zip code(Required)

Legal state(Required)

Years at legal address(Required)

Contact information

Phone number(Required)

Email(Required)

Family Information

Parent's names(Required)

Parent's occupations(Required)

Parent's addresses(Required)

Education Information

High school(Required)

Graduation date(Required)

Pre-medical school(Required)

Graduation date(Required)

Present medical school(Required)

When did/will you enter medical school?(Required)

When do you expect to receive your MD or DO degree?(Required)

Have you attended any other medical schools?(Required)

Yes

If so, when and where?

What specialty, if any, have you selected or do you intend to select?

Please tell us something about yourself.(Required)

Where do you think you might like to practice?(Required)

Are you applying, or have you in the past applied, to the Hanley Center for Health Leadership & Education Medical Student Loan Program (through FAME)? (If no, please submit a letter of recommendation or copy of acceptance to medical school.)(Required)

Yes

I have completed this application with accurate and true information.(Required)

Yes