2018 Diversity in Medicine Scholarship Application
For the Academic Year 2018-2019

Applications and all supplemental material are due by Monday, June 18, 2018 (midnight, EST).

For any questions, please email AMSNY at scholarship@amsny.org or call at 212.218.4610.

First and Last Name: *
School Email Address: *
Personal (Non-School) Email Address: *
Mailing Address (Street Number, Street Name, Apartment Number, City, State, Zip Code): *
Permanent Address (Street Number, Street Name, Apartment Number, City, State, Zip Code):
Phone Number (No Spaces, Dashes, or Parentheses, Just 10 Digit Number): *
Eligibility Criteria
In order to be eligible for the AMSNY Diversity in Medicine Scholarship, you must meet certain criteria as outlined below.
Have you been or are you currently a student in one of the four AMSNY Post-Baccalaureate Programs? *
Which program did you attend? *
Are you domiciled in New York State? *
Please note, the criteria for determining whether an individual is domiciled in New York State are the same as those used for determining SUNY in-state tuition and can be found at https://www.suny.edu/sunypp/documents.cfm?doc_id=402
Are you enrolled in a medical school in New York State for the 2018-2019 academic year? *
Medical School: *
Year of Expected Graduation: *
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