Scholarship Application Form - Formstack

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Scholarship Application

Please fill out a separate form for each scholarship.

Please note: All prospective students must be accepted prior to applying for a Scholarship.

Personal Information

First Name*

First Name

Last Name

Address 1*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Email*

Phone

Semester you intend to start*

Class*

Scholarships

Select the scholarship for which you are applying:*

This scholarship is awarded to all students who have taken the initiative to write the MCAT. The value of this scholarship will be dictated by their score on the exam.

Please upload your MCAT results here.*

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XUSOM is a proud supporter of increasing gender inclusivity in the medical field. With this scholarship we hope to help lessen the gap between males and females working in the STEM field.

Are you a woman who has majored in Science, Technology, Engineering, or Mathematics?*

Was your cumulative undergraduate GPA a 3.0 or higher? Please have your official transcript sent directly to XUSOM, as well.*

Please submit a video (between 2-3 minutes) describing what makes you passionate about joining the STEM field as a woman.

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Are you an incoming MD1 student?*

Are you classified as an under-represented minority (African American, Native American, Hispanic, etc.)?*

Please upload proof of U.S. Citizenship or permanent resident status here.*

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Are you currently an active US military member?*

Have you completed your US military service?*

What year did you complete your service?*

Please upload your proof of service.*

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Please upload a video (less than 4 minutes long) about one of the following: 1. Describe how you plan on helping increase the number of underrepresented minorities in medicine either in the near future or once you are in a position of power, or 2. Speak upon how you will attempt to further John Lewis' legacy of fighting inequalities in your professional and personal life. - Copy

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Did you graduate from a NY high school and are now entering the XUSOM Pre-med program?*

Are you transferring into Xavier for MD6 with a minimum GPA of 3.0 from your previous medical school?*

Please tell us the medical schools you have attended, including years attended.*

Please submit your official NBME and CBSE scores. Your GPA will be verified from the transcripts you have submitted.*

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Are you a New York resident who matriculated from a SUNY, CUNY, or NY State Community College?*

Please list the NY school(s) from which you graduated, the degree awarded, and your month and year of graduation. - Copy - Copy*

Please submit a personal essay (no more than 750 words) or video (2-3 minutes long) describing how you have given back to your community. - Copy*

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Are you already working in the medical field in a hands-on setting as a Nurse, PA, EMT, etc.?*

Please describe what you do:*

You are not eligible to apply for this scholarship.

Scholarship/Grant Terms:

I. Must have continuous enrollment.

II. Must maintain satisfactory academic progression at the discretion of Chief Academic Officer.

III. No disciplinary actions of any sort while a student of XUSOM.

IV. Must reside at on-campus housing during basic science semesters.

V. Tuition must be fully paid by the due date.

*

I have read and acknowledge the Scholarship/Grant Terms above and understand that a scholarship may be revoked if terms are not met.

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