Morgagni Medical Scholarship Application
Email address *
I understand that the Morgagni Medical Scholarship is only for incoming first year medical students starting in the fall of 2019 who are of at least 50% Italian descent and a college overall GPA of at least 3.5. *
Required
Prefix *
Your answer
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Suffix
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Country of Residence *
Your answer
Daytime Phone *
Your answer
Evening Phone *
Your answer
Cell Phone
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
How did you hear about the Morgagni Medical Scholarship? *
Your answer
Do you or your family know any Morgagni Medical Society or Columbus Citizens Foundation Members? *
Please list any Morgagni Medical Society or Columbus Citizens Foundation Members known or possibly known to you and your family and your relationship to them.
Your answer
Please list the complete name and address of your undergraduate school *
Your answer
GPA *
A college overall GPA of 3.5 required for scholarship eligibility. Official college transcript required for verification.
Your answer
Undergraduate School Major(s) *
Your answer
Undergraduate School Minor(s)
Optional
Your answer
Is the student or a sibling of the student a past or current Columbus Citizens Foundation scholarship recipient? If yes, please list the relevant scholarship recipient name(s). *
Your answer
List all tuition assistance, scholarships, awards and grants you have received toward your medical school education. Please distinguish between what is a loan and what is a grant. (Note: Loans must be repaid over time with interest, whereas grants are financial awards that are given to you at no cost). If none, please indicate "None". *
Your answer
List medical schools admitted to for Fall 2019 *
Your answer
What percentage of your heritage is of Italian descent? *
Your answer
List your MATERNAL GRANDMOTHER in the following format: Name, Birthplace, Italian City of Family Origin, Percentage Italian. Example: Lucia DeVito, Brooklyn, NY, Avellino, Italy, %50." (Enter N/A if not Italian). *
Your answer
List your MATERNAL GRANDFATHER in the following format: Name, Birthplace, Italian City of Family Origin, Percentage Italian. Example: Lucia DeVito, Brooklyn, NY, Avellino, Italy, %50." (Enter N/A if not Italian). *
Your answer
List your PATERNAL GRANDMOTHER in the following format: Name, Birthplace, Italian City of Family Origin, Percentage Italian. Example: Lucia DeVito, Brooklyn, NY, Avellino, Italy, %50." (Enter N/A if not Italian). *
Your answer
List your PATERNAL GRANDFATHER in the following format: Name, Birthplace, Italian City of Family Origin, Percentage Italian. Example: Lucia DeVito, Brooklyn, NY, Avellino, Italy, %50." (Enter N/A if not Italian). *
Your answer
List extracurricular, community & religious activities. Include length of service, offices held, etc. Describe your hobbies and any awards, certificates, or medals you have received. *
Your answer
List ACADEMIC activities, accomplishments and/or recognition you have received. *
Your answer
Describe the academic interests, personal perspectives and Italian life experiences that make you the ideal candidate to receive this award and explain how you intend to incorporate your Italian heritage into your practice of Medicine. Please type your essay and save in Word or PDF format. Make sure to include your name and date of birth so the documents are matched with your application. *
Required
Please acknowledge that you must submit two letters of recommendation that specifically address why you should be selected as a scholarship recipient. Do not submit recommendations used for medical school admission. One recommendation should be of an academic nature (i.e. Professor, Dean of Students, Guidance Counselor, etc.). The other one should be of a non-academic nature (i.e. Community, Church, Employer, Coach, Youth Group Coordinator, etc.). Do not send more than two letters of recommendation. Make sure to include your name and date of birth on the documents or the envelope (if sealed) so that they are matched with your application. *
Required
Please acknowledge that you must submit a sealed official school transcript. *
Required
Explanation of Special Circumstance - if there are special circumstances that you feel the committee should be aware of, please describe concisely.
Your answer
Please acknowledge that Columbus Citizens Foundation and/or the Morgagni Society will be communicating with you by email to the email addressed linked to this application. Please ensure that the email address provided is correct. *
Required
Please acknowledge that supporting documentation may be submitted anytime between February 1 and June 1, 2019. I UNDERSTAND THAT WITHOUT ALL OF THE REQUIRED SUPPORTING DOCUMENTATION MY APPLICATION WILL NOT BE CONSIDERED. Supporting documentation includes: Two (2) letters of recommendation; essay; copy of medical school application essay, college transcripts. *
Required
I affirm that all the above information is true. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.