This form is to be filled out by currently matriculated Weill Cornell Medical College students, who have qualified for need based financial aid. This is neither an application to the Medical School nor an application for financial aid. The information will be used for evaluation of financial aid awards as well as to create brief biographical reports to be sent to the appropriate donors of scholarship funds.

Resumes or CVs may be e mailed, in place of filling out this form, to: low2001@med.cornell.edu.

* Required fields
Note all fields are mandatory, if the field does not apply to you please type "N/A"

General Information:
*First Name:
*Last Name:
* Email:
* Confirm Email:
*Gender:	Male Female
*WMC Class Year:
*Hometown:
EDUCATION:
Undergraduate
*School:
*Major:
*Degree:
*Year:
Postgraduate
*School:
*Major:
*Degree:
*Year:
*CAREER GOALS:
Please indicate the field(s) that interest you as career options
*Career 1:
*Career 2:
*Career 3:
*Career 4:
COMMUNITY SERVICE:
*Undergraduate and Postgraduate:
*Medical School:
*Other:
RESEARCH EXPERIENCE:
*Undergraduate:
*Postgraduate:
*Medical school:
*Published papers/articles:
*AWARDS AND HONORS:
*Undergraduate:
*Postgraduate:
*Medical school:
ADDITIONAL PERTINENT INFORMATION:
*Travel/study abroad:
*Extracurricular activities:
*Creative interests or background: