National Conference Application - Mississippi Academy of Family Physicians

This award provides a unique opportunity for family medicine residents or medical students to attend a national family medicine conference. A scholarship of up to $1,000 may be awarded to help reduce out-of-pocket expenses associated with attending the conference.

Eligibility:

a member of the Mississippi Academy of Family Physicians
A resident or medical student in good standing
attending a national family medicine conference for the first time

National Conference Scholarship Application

Name*
First Last
Type of Applicant*
Medical School You Attend*
Year in Medical School*
Residency Program*
Year in Residency*
Email*
Mobile Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Conference Choice
Conference You Wish to Attend:
Personal
Hometown
(city, state, country)
Please upload your photo here*
Drop files here or

Max. file size: 50 MB.
Social Media Handles
Simply so we can tag you when we post.
Instagram Handle
Facebook Name
Twitter Handle
Eligibility Rules & Regulations
Application and essay must be received no later than 14 days prior to the Early Bird Registration deadline for the conference. Winners will be selected by a panel of judges and notified prior to the last day of the Early Bird Registration for the conference. Up to $1,000 will be awarded to defray costs to attend the conference. If selected, you will be reimbursed for your expenses after attending the conference, pending receipt of a 1-page typewritten report of your experiences.
Verification of Eligibility
You must have a dean or department chair of the medical school, or department chair of the residency, verify that you are a medical student or resident in good standing. Please provide their contact information and they will be e-mailed about your application.
Dean/Chair/Director's Name*
First Last
Dean/Chair/Director's E-mail Address:*
Additional Questions
You can type in the blanks below or attach a file containing your typed answers.
Attach File(s) Here if Desired
Drop files here or

Max. file size: 50 MB.
Have you applied for, or received, a scholarship to attend the conference through another organization? If yes, please indicate the name of the organization and the amount of the scholarship you were awarded:
Describe in 500 words or less (1) your interest in family medicine and (2) how attending this conference will enhance your ability to practice family medicine in Mississippi:*
Application Deadline
The deadline to apply for a National Conference scholarship is two weeks prior to the Early Bird Registration deadline for the event.
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This award provides a unique opportunity for family medicine residents or medical students to attend a national family medicine conference. A scholarship of up to $1,000 may be awarded to help reduce out-of-pocket expenses associated with attending the conference.

National Conference Scholarship Application

Conference Choice

Personal

Social Media Handles

Eligibility Rules & Regulations

Verification of Eligibility

Additional Questions

Application Deadline