Howard University Medical Alumni Association, Inc.

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2011-2012 HUMAA SCHOLARSHIP PROGRAM

Students must submit an application to be considered for a Howard University Medical Alumni Association, Inc. (HUMAA) scholarship. A committee, composed of alumni, will review the applications and determine the recipients.

APPLICATION
The application consists of two parts:

1. APPLICATION FORM
The application form requires the student to provide basic biographical and educational information. THE STUDENT'S SIGNATURE AND HOWARD UNIVERSITY I.D. NUMBER ARE REQUIRED.

2. PERSONAL STATEMENT
A personal statement of not more than 500 words is to be written by the student and submitted with the application.

DEADLINE
Applications must be submitted to HUMAA by 5:00 PM WEDNESDAY, FEBRUARY 8, 2012. You may submit the application on line at www.HUMAA.com (click on Scholarship Forms) or deliver it to the HUMAA office located at:

2225 Georgia Avenue, NW, Ste. 801
Washington, DC 20001
(202) 238-2586
Fax: (202) 986-1572

If you are awarded a HUMAA scholarship, your financial aid through Howard University may have to be adjusted to accommodate the scholarship. If you have questions regarding how the HUMAA scholarship may affect your financial aid, you should contact the College of Medicine’s Financial Aid Office.

SCHOLARSHIP APPLICATION

Name:

Year in School:

Anticipated specialty:

Research interests:

Date of Birth:

Place of Birth:

Ethnicity:

If not a U.S. citizen, list country of citizenship:

Gender:
Male Female

Marital Status:

No. of dependents:

Current Address:

City:

State:

Zip Code:

Telephone:

Cellphone/Pager:

Email Address:

Permanent Address:

Permanent City:

Permanent State:

Permanent Zip Code:

Sources of income while attending medical school:
Parents Spouse Loans Scholarships Work Other

In what state did you attend elementary school?

In what state did you attend high school?

Name of your undergraduate college or university?

What graduate school(s) have you attended?

Other:

List Honors and Awards received in undergraduate, graduate and/or medical school:

List all research fellowships received in undergraduate, graduate and/or medical school:

List in chronological order, professional, social, civic and student organizations, in which you have participated over the past four years:

Provide the title and citation for all articles you have had published:

All applicants must provide a personal statement of not more than 500 words discussing the following:

Significant persons and/or events that have influenced your decision to pursue a career in medicine
Your personal and professional goals over the next ten years
How this scholarship would benefit your medical training
Describe your financial need

I authorize Howard University College of Medicine (HUCM) to release information concerning my academic status, my class rank and financial aid package to Howard University Medical Alumni Association, Inc. (HUMAA) in support of my application for a HUMAA Scholarship. I understand this application will be reviewed by members of HUMAA Scholarship Committee and give my permission for the application and supporting documentation to be copied and distributed for this purpose.

Howard University I.D. Number:

Type Name or Signature: