Form-2

The Polish-American Medical Society Academic Fund provides tuition scholarship to qualified full time graduate students from Chicago region for medical, dental or veterinary studies in the United States and in Poland. The application form must be filled out and submitted online. All the corresponding documents, including letters of recommendation, school transcripts and processing fee must be received by March 30th, each year.

Applicant must: be a United States citizen or a permanent resident of Polish descent from Chicago region, be (or be admitted) as a medical, dental or veterinary school full time student in the United States or in Poland and have a minimum GPA of 3.0. Selection is based on academic excellence, applicant’s other achievements, interests and motivation, applicant’s interest and involvement in the Polish-American community and financial need. For all questions, please contact Vice-President and Director of Scholarship Committee Dr. Ewa Radwanska. M.D.

**As the form may refresh while you are filling out the application, we recommend you type up the answers in a separate word document and paste them all at the same time once they are completed.

1. Name *
Please fill out in completion and submit all documents, photo, and fee for consideration

Name(Required)

Email *

3. Mailing Address

Address(Required)

5. Phone *

Phone(Required)

6. Country of Birth *

6. Country of Birth

7. Date of Birth *

Date

8. Residency Status *

Residency status(Required)

US Citizen

US Resident

Polish Citizen

Other

9. Education History *
Please name all institutions attended after high school including dates of study, degrees received, majors.

Education History

10. Enrollment Status *

Enrollment Status

Full-Time

Part-Time

11. Level of Enrollment *
Check all which apply

Level of Enrollment

Level of Enrollment other(Required)

12.Detail of University *

Name of University

Curremt Major

14. G.P.A

n Prusuit of Which Degree(s)?

If First Year, High School GPA

What are your present academic and professional plans? *

What are your present academic and professional plans?

What fellowship or financial grants do you presently hold if any? *

What fellowship or financial grants do you presently hold if any?

How much financial aid will you receive monthly from your parents or other sources?*

How much financial aid will you receive monthly from your parents or other sources?

13. If you are currently studying for a Doctorate, what is the proposed title of your dissertation? *

13. If you are currently studying for a Doctorate, what is the proposed title of your dissertation?

14. Is the scholarship you seek to be used at another institution? *

14. Is the scholarship you seek to be used at another institution?

Yes

If Yes, which Institution?

15. Describe your proposed course of study *

15. Describe your proposed course of study

16. What other scholarships or grants will you receive, or for what other grants are you applying? *

16. What other scholarships or grants will you receive, or for what other grants are you applying?

How much financial aid do you expect to rely upon this academic year? *

How much financial aid do you expect to rely upon this academic year?(Required)

How much financial aid will you receive monthly from your parents or other sources? *

How much financial aid will you receive monthly from your parents or other sources?(Required)

17. List honors and distinctions you have achieved as a student *

17. List honors and distinctions you have achieved as a student

18. Have you had any articles, theses or books published? If so, please indicate their titles, place and date of publication. *

18. Have you had any articles, theses or books published? If so, please indicate their titles, place and date of publication.

19. How would you rate your knowledge of Polish? *

19. How would you rate your knowledge of Polish?(Required)

20. What have been your interests and activities outside your schoolwork or professional activities? *

20. What have been your interests and activities outside your schoolwork or professional activities?(Required)

21. Please respond to the following essay question: to what extent have you participated in Polish-American activities, and how has your involvement impacted you? *

21. Please respond to the following essay question: to what extent have you participated in Polish-American activities, and how has your involvement impacted you?(Required)

22. In addition to the online application, you must send two (2) letters of recommendation. *(Required)

Letter of recommendations should be signed originals, on letterhead and an official transcript from your current school. If not presently enrolled in any school, send transcript from the last school, which you did attend. List two (2) professors under whom you have studied or two (2) authorities in your field who can attest to your academic or professional ability, from whom you will request letters of recommendation. Include their name, title of the position, address and the telephone.

22.5 Upload Docs(Required)

Drop files here or

Max. file size: 100 MB.

23. Upload Photo(Required)

Headshot

Max. file size: 100 MB.

24. Along with the application materials, I will enclose a check for a non-refundable fee of $30

You Will be Taken To Paypal Upon Submission ($30)

Price:

25. Have you been involved with the Polish American Medical Society in the past? How do you plan to participate and contribute to the Polish American Medical Society in the future? If you are a previous recipient of the scholarship, please describe your involvement in PAMS and/or Junior PAMS since being awarded the scholarship.(Required)

Date of Application *

Date(Required)

Aplplication Fee

Electronic signature

Chose payment

I will be paying online

want to send check

SUBMIT FORM and GOTO Paypal

SCHOLARSHIP APPLICATION – ACADEMIC FUND