Robert E. Pieroni, MD, and Family Endowed Scholarship – College of Community Health Sciences

First Name *

Last Name *

CWID *

Email *

Primary Care Interests and Intents *

Describe your interest in and your intent to practice primary care.

Financial Obligations *

Please list your financial debts and obligations as they relate both directly and indirectly to medical school.

Merit *

Please briefly summarize why you should be considered for this scholarship outside of your financial need, including a description of your academic accomplishments in medical school.

What best characterizes your academic performance in medical school *

Many academic challenges

Some academic challenges

Average student

Above average student

Well above average student

Medical School Academic Performance Comments *

(Optional)

What best best characterizes your clinical performance in medical school thus far *

Repeated one or more clerkships

Satisfactory

Honors in half or fewer clerkships

Honors in more than half of clerkships

Medical School Clinical Performance Comments *

(Optional)

Your total amount of debt related to medical education *

Other Scholarships *

List scholarships, over $5,000, that you have received to support your medical education. Provide the name and approximate amount of money from each scholarship. If you have not received other scholarships enter "Not Applicable".

What other financial awards or scholarships have you received to apply toward the cost of your medical training? *

In regards to the above, what is the total amount of scholarship or award monies you have received or are going to receive? *

Scholarship Committee Review *

I understand that the CCHS Scholarship Committee (composed of faculty, staff, and community members) will review my application and discuss my academic and clinical performance as well as my financial situation.

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