PAUL SPEAR APPALACHIA SCHOLARSHIP APPLICATION

Application deadline is June 20, 2014

I would like to apply for the Paul Spear Appalachia Scholarship. I understand the award is based on the desire to provide health care in the Southeastern Ohio and/or Appalachia area and financial need. I also understand that during the selection process, information regarding my outstanding federal student loan(s) will be gathered and reviewed by the selection committee. If awarded the scholarship, I agree to practice in the Southeastern Ohio and/or Appalachia area as repayment of the scholarship on a one-for-one year basis.

  1. Large city (population 500,000 or more)
    Suburb of a large city
    City of moderate size (population 50,000 to 500,000)
    Suburb of moderate size city
    Small city (population 10,000 to 50,000 other than suburb)
    Town (population 2,500 to 10,000 other than suburb)
    Small town (population less than 2,500)
    Rural/unincorporated area

  2. Cardiology
    Cardiothoracic surgery
    Dermatology
    Emergency medicine
    Family practice
    Gastroenterology
    Geriatrics
    General internal medicine
    General surgery
    Hospital medicine
    Neurology
    Neurosurgery
    Obstetrics/gynecology
    Orthopedics
    Otolaryngology
    Pediatrics
    Physical medicine – rehabilitation
    Public health – preventive medicine
    Psychiatry
    Undecided or no preference
    Urgent care
    Other:

  3. Large city (population 500,000 or more)
    Suburb of a large city
    City of moderate size (population 50,000 to 500,000)
    Suburb of moderate size city
    Small city (population 10,000 to 50,000 other than suburb)
    Town (population 2,500 to 10,000 other than suburb)
    Small town (population less than 2,500)
    Rural/unincorporated area

  4. Yes
    No
    Not sure

  5. Yes
    No
    Not sure