Financial Literacy

B.A./M.D. Scholarship Application

UMKC School of Medicine
B.A./M.D. Scholarship Application Form
Applicant Information:
Date of birth (mm/dd/yy}:
First Name:*
Last Name:*
Middle Name/Initial:
UMKC E-mail:*
Cell Phone:*
Home Phone:
Ethnicity (check all that apply):
Current Legal Address:
Current Legal Address:*
Current Legal County:
Current Mailing Address (if different from Legal Address):
Current Mailing County:

High School Information:

High School Name:*
Year of graduation:*
Residency Status - Please select the correct option from the listing below:*
If applicable, how long have you been a Missouri resident? Years / Mos.
School of Medicine Information
What year will you promote to in June?:*
M.D. Program?*
Graduation Year:*
School of Medicine Information:

Curriculum Vitae
List major school and community activities, awards, scholarship awards, honors or offices held, and years held. - ( 500 words or less)

Family Responsibilities
Briefly describe your family responsibilities (250 words or less)

Debt Reduction
Describe what steps you have taken to reduce student loan debt. - ( 250 words or less)

Financial Situation
Describe your financial situation- ( 250 words or less)

Donor Impact Statement
Each year, we share information about student scholarship recipients with donors in a Donor Impact Statement. Please write a short paragraph about yourself to be used as your Donor Impact Statement if selected for a scholarship (see sample). Please include your name, hometown, year in the program, involvement and activities, honors and awards, interests, hobbies, etc.

Sample: Susie Johnson is a year 6 student from St. Louis, MO. Susie is a member of the Emergency Medicine Interest Group, the Medical Student Advisory Council and serves as a School of Medicine Student Ambassador. Susie participated in a two-month research experience at St. Jude's Children's Hospital in her 5th year of the program, and hopes to enter a pediatrics residency after graduation. In her spare time, she enjoys reading, volunteering with Big Brothers Big Sisters, and running.

Do you have a specialty of interest?

What are your plans after completing your residency?

By signing here I give permission for the Financial Aid & Scholarships Office to share the amount of total indebtedness with the UMKC School of Medicine for the Year 3-6 Scholarship application purpose.

Signature = UMKC Email address*
Date = 00/00/00*

Please click the SUBMIT button to complete.
Note: If the form does not submit, and you do not receive a confirmation page, a required entry may be missing. Please scroll through the form. Missing (required) answers should be highlighted in red. Enter the required information and submit again.