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2004-05 NATIONAL MEDICAL ASSOCIATION SPECIAL AWARD PROGRAMS
CANDIDATE INSTRUCTION SHEET
The National Medical Association is sponsoring three special award programs that recognize and reward African-American/black medical students for special achievements, academic excellence, leadership and potential for significant contributions to medicine.
The Patti LaBelle Scholarship and The NMA Emerging Scholar Awards are the highest honors presented to students by the National Medical Association. These awards recognize academic achievement, leadership and potential for distinguished contributions to medicine. Presented to current first, second, and third-year medical students, these awards also have a need component.
The Patti LaBelle Scholarship will be presented this year to the highest ranked candidate; the cash prize is $5,000. Each NMA Emerging Scholar Awards will include a cash prize of $2,250.
The JNMA Awards for Medical Journalism are given to students who demonstrate skill and interest in medical journalism. These awards also recognize academic achievement and leadership. Candidates must be in the third or fourth years of medical school and must have published articles and photographs in, or been writers, editors or photographers on the staffs of:
Medical school newspapers; Medical student journals, such as the Journal of the Student National Medical
Association or the New Physician magazine; Recognized professional journals such as the Journal of the National Medical
Association, the Journal of the American Medical Association, or the New England Journal of Medicine; or
Other respected scientific journals.
Students who have written, produced or directed health-related films, commercials or videos are also encouraged to submit their applications and samples of their work in consideration for an Award in Medical Journalism.
The Awards in Medical Journalism include a cash prize of $2,500.
Eligibility and Selection Criteria
Eligibility for these awards is limited to African-American medical students. Your school may submit two nominations for NMA Emerging Scholar Awards and two for the Awards in Medical Journalism—a total of four nominations.
The general application materials submitted for each nominee must include:
A letter of recommendation that fully discusses the candidate’s academic performance, extracurricular activities and other qualifications for the scholarship.
A scholarship program application form in which the student provides basic biographical and educational information.
An essay of at least 500 words written by the student. The essay should discuss his or her motivation for a career in medicine and career plans over the next ten years.
An official academic transcript.
For Emerging Scholar nominees only: A financial aid transcript submitted by the medical school financial aid office, that itemizes the sources of scholarship and loan support as well as an estimated budget and award package for the 2004-05 year. Students must also provide income tax returns for themselves, their parents and spouses. The required form is included with the application.
Applicants for the JNMA Awards in Medical Journalism must also submit samples of their work (articles, photographs, audio tapes, video tapes, etc.) for review by the selection committee. Printed articles and photographs may be submitted in the form of clippings, reprints or photocopies showing the names and dates of the publications in which they appeared. Broadcast (radio and television), film and video entries should be submitted as scripted material accompanied by audiocassettes or 3/4" videocassettes. Entries must have been published or produced within the last three years.
NMA Merit Scholars will be selected on the basis of:
Documented financial need Leadership and community involvement Academic achievement Potential for outstanding contributions to medicine
The criteria for selecting the JNMA Medical Journalism Scholars include:
Demonstrated journalistic skill Leadership and community involvement Academic achievement Potential for outstanding contributions to medicine
Deadline Date and Announcement of Winners
The deadline for submission of application materials is May 7, 2004. Award winners will be announced to the medical schools by June 30, 2004 and at the annual convention of the National Medical Association in August. Award checks will be distributed in September 2004.
THE ORIGINAL PLUS ONE COPY OF ALL APPLICATION MATERIALS SHOULD BE FORWARDED IN ONE PACKAGE TO:
THE NATIONAL MEDICAL ASSOCIATION SPECIAL AWARDS PROGRAMS
National Medical Fellowships, Inc.5 Hanover Square, 15th Floor
New York, NY 10004(212) 483-8880
THE NATIONAL MEDICAL ASSOCIATIONSPECIAL AWARD PROGRAMS
2004 APPLICATION FORM
[ ] Please check here if you are applying for an Award in Medical Journalism
Please Print All Responses
Name: SSN: Last First MI
Medical School:
Year in School: Expected Date of Graduation:
Date of Birth: Place of Birth:
Gender: Male Female U.S. Citizen: Yes No
If naturalized citizen, please provide certificate number: and include proof of citizenship
Marital Status: Widowed Single Married Divorced
Spouse’s Name: ___________________
How did you learn about this program?
Current Address: Number Street Apt. #
City State Zip Telephone
Permanent Address: Number Street Apt. #
City State Zip Telephone
E-Mail Address:
Parental Information
Father: Mother:
Occupation: Occupation:
Address: Address:
City/State/Zip: City/State/Zip:
Telephone: ( ) Telephone: ( )
1
EDUCATION
Name LocationDates
Attended Major DegreesHigh School
Undergraduate
Graduate
Other
List all honors or awards received in undergraduate, graduate and medical school. (Use additional sheets if necessary)
Name of Award Citation School Date
List all research fellowships received in undergraduate, graduate and medical school. (Use additional sheets if necessary)
Name of Fellowship School Date
List in chronological order, major professional, social, civic and student organizations, in which you have participated over the past four years, include offices held. (Use additional sheets if necessary)
Date Activity
FOR NMA THE AWARDS IN MEDICAL JOURNALISM
Type of submission(s) (Check all that apply)
____ School newspaper _____ Professional journal _____ Video____ School magazine _____ Radio____ Student journal _____ Television
Titles of entries submitted:
For newspaper and magazine entries:
Published in Date
For radio or television entries:
Original date and time of broadcast Station Length of original program Length of material entered
For video entries:
Audience and purpose of video Length of material entered How was material distributed and by whom
PERSONAL STATEMENT: All applicants must provide a statement of least 500 words discussing your personal and professional goals over the next ten years. Emphasize significant persons and/or events that have influenced your decision. Your name, medical school and social security number must appear on each page.
I authorize my medical school to release information concerning my academic status and financial aid package to National Medical Fellowships, Inc. in support of my application for a National Medical Association award. I understand this application will be reviewed by members of the NMA Council on Talent Recruitment, Retention and Financial Aid and give my permission for this application and supporting documentation to be copied and distributed for this purpose. My signature affixed to this page also authorizes NMF to request follow-up information about me from my medical school, state licensing boards and all professional and academic associations with which I have or will have an affiliation or from which NMF can retrieve biographical and career information.
Signature of Applicant Date
List the names of your hometown and local/school newspapers.
______________________________________________________________________________
Please forward original plus one copy of all required application materials to:
NATIONAL MEDICAL ASSOCIATION SPECIAL AWARDS PROGRAMSNational Medical Fellowships, Inc.
5 Hanover Square, 15th FloorNew York, NY 10004
(212) 483-8880
Deadline for receipt of application materials: May 7, 2004
Faxed applications will not be accepted.
The 2004 National Medical Association Special Award Programs
Application Checklist
A Recommendation from the medical school dean or assignee
Completed Application
Personal Statement
Official Academic Transcript
A Financial Aid Transcript–For Emerging Scholar Awards nominees only
Samples of Printed Articles, Photographs, Audio Tapes, Video Tapes, etc.–For NMA Awards in Medical Journalism nominees only
THE ORIGINAL AND ONE COPY OF ALL APPLICATION MATERIALS SHOULD BE FORWARDED BY MAY 7, 2004 TO:
THE NATIONAL MEDICAL ASSOCIATION SPECIAL AWARDS PROGRAMSNational Medical Fellowships, Inc.
5 Hanover Square, 15th FloorNew York, NY 10004
(212) 483-8880
Facsimiles will not be accepted.
FINANCIAL AID TRANSCRIPT AND EVALUATION FORM – NMA PROGRAM INSTRUCTIONS: An NMF scholarship applicant attending medical school must submit this transcript to document all financial aid received at the medical school. The applicant should complete Section A and have the financial aid office at the medical school complete Section B and return this form to NMF by May 7, 2004.
SECTION A: (To be completed by applicant)
Name:___________________________________________________________ Social Security # : ______--____--______ Last First MIName previously used at medical school (if different from above)____________________________________________
I authorize the financial aid office at __________________________________________________, which I have attendedName of School
since ________________ to provide the information requested by NMF.Month/Year
Please submit to:Cynthia Seay Student’s Signature
National Medical Fellowships, Inc.5 Hanover Square, 15th Floor Street Address
New York, NY 10004City State
Zip
SECTION B: (To be completed by the financial aid office at the medical school)A COMPLETED TRANSCRIPT IS NECESSARY IN ORDER FOR YOUR STUDENT TO BE CONSIDERED FOR AN AWARD.
The award information requested below cannot be provided because the student:
Did not apply for aid Was not eligible for aid No funds availableOther:_____________________________________________________________
Award Years and Amounts of AssistanceSources of Assistance 2003-04 2002-03 2001-2002 2000-2001 1999-2000
Federal PerkinsFederal HPSL/PCLFederal Stafford-SubsidizedFederal Stafford-UnsubsidizedHEALLDSOther Loans (identify)
EFNNHSC ScholarshipAFHPSBIASSIG/State GrantFADHPSSDSNMFInstitutional GrantOther Grants/Scholarships (identify)TOTAL GRANTS/SCHOLARSHIPS
Expected Family ContributionUnmet Need
OVER
Academic year for which Medical Schoolassistance is requested:___________ Class Year:___________
Please itemize the actual cost to be incurred by the student at your institution this year:
Student Budget
Tuition $_____________
Fees $_____________
Room and Board $_____________
Indirect/Misc. Expenses $_____________
Total School Approved Budget $_____________
Is this student subject to higher non-resident tuition cost? YES NO
Comments:
Name:________________________________________________(Please type or print)
Title:_________________________________________________
School:_______________________________________________
Telephone:(_____)_________________ Date: __________
Signature:_________________________________________
This transcript must be received by NMF’s office no later than May 7, 2004 in order to complete your student’s scholarship application.