Fort Bend Medical Society

A Non-Profit Organization
Ft. Bend County
2014-2015 Scholarship Application
The Fort Bend Medical Society (FBMS) scholarship program is based upon the requirements listed on the reverse side of this application. The
FBMS will award the scholarships. All decisions are final. Scholarship payments will be made through the Student Financial Aid Department
of the college/university of choice. The scholarship will be for the 2014 Fall school semester and the 2015 Spring school semester.
A. Applicant:
Name ______________________________________________________________________________________________
Last
First
MI
Preferred Name
Sex
Mailing Address______________________________________________________________________________________
Home Phone______________________________ E-Mail_____________________________________________________
Cell Phone______________________ Date of Birth_______________ College ID or SSN___________________________
B. Family:
Guardian/Parent ______________________________________________________________________________________
Address____________________________________________________________Phone____________________________
Brothers/Sisters: Name_______________________________________ Age_________________ In college?_________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
C. College Plan: College____________________________________ Degree Objective___________________________________
D. What scholarships, grants, and/or loans and in what amounts have you received to date? (List if for one year or reoccurring)
____________________________________________________________________________________________________
____________________________________________________________________________________________________
E. Employment Background: (Company, type work, dates)
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
F. What activities, leadership roles, volunteering have you done in High School? (Number of years involved)
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Note: if more space is needed to answer the question(s), you may attach additional pages.
The interview location and date will be determined and announced.
The undersigned attest to the accuracy of the information provided. In addition, your signature indicates that you have read the
scholarship requirements on the reverse side and authorizes Fort Bend Medical Society Scholarship Committee to substantiate any of
the data provided herein. False statements shall be cause for immediate cancellation of the scholarship.

Applicant (Signature) ____________________________________________

Date _________________________________

ISD: (Ft. Bend or Lamar Consolidated ISD) ___________________________

High School ___________________________

Fort Bend Medical Society

Scholarship Requirements

The information provided is to be used by Fort Bend Medical Society Scholarship Committee for the sole purpose of
evaluating candidates for scholarships.
1. The candidate shall be a United States citizen or permanent resident of the United States and a resident of Fort Bend
County. He/she shall be a High School Senior, graduating in May, 2014 at a Ft. Bend ISD or Lamar Consolidated
ISD high school campus and having been accepted for Fall attendance at an accredited college in Texas. The
scholarship is intended for those students who desire to attend medical school. The graduating senior must have at
least a final GPA of 3.0.
2. The scholarship award is a fixed amount, $1,000, and is to be applied to normal tuition and fees. Scholarship
monies will be deposited by the FBMS into his/her student account at his/her respective college.
3. The duration of the scholarship is for the scholastic year beginning no later than the fall semester following the
award.
4. The top ten (10) applicants will be chosen based on an accumulation of grade point/school standing and SAT/ACT
scores. From these, the top five (5) will be chosen based on their essay. The final five (5) students will interview
for the scholarship(s).
5. The candidate will completely and accurately fill out the application; include the college acceptance letter; and
official transcript with SAT/ACT scores. He/She will submit a typed double-spaced paper, 500-1,000 words on the
subject Todays healthcare is going through a massive reform. What is your motivation in pursuing medicine
during this challenging period? Please relate some experiences or personal reflections that have allowed you to
choose medicine as your potential career path.
6. The deadline for the application is Monday, May 19, 2014 to the School Counselor. The Scholarship Committee
will pick up from the School Counselor all applications which must include the following four items: (1)
completed application, (2) college/university acceptance letter, (3) written essay, (4) official copy of the
applicants latest transcript including SAT/ACT scores.
7. Failure to accurately complete #5 and #6 will result in elimination for scholarship consideration.
8. The candidates shall be available for an interview with the Scholarship Committee. Candidates will be notified
regarding specific interview date and time. There will be no make-up days. The interview process is a
requirement for scholarship consideration.
9. The candidates shall be notified of the Scholarship Committees selection a week after all the interviews are
completed. The recipients will be recognized at the annual social event (date TBA).
10. The Scholarship Committee shall hold all information provided herein confidential.
11. The candidate specifically authorizes the Fort Bend Medical Society Scholarship Committee to substantiate any
data provided herein.

Fort Bend Medical Society Scholarship Committee

Dr. Paul Loubser
Dr. Art Klawitter
Dr. Shreyas Bhavsar
Dr. Neetee Gadgil
Dr. Lauren Swords

For additional information contact:

Vickie Lynn Tonn

Executive Director, FBMS
email: vickietonn@yahoo.com
Ofc. Ph: 281-239-2178
Cell Ph: 713-502-5791