2011 TMLT Memorial Scholarship

4. How have you paid for medical school (list percentages totaling 100 percent)?________________ self-employment________________ family________________ spouse________________ scholarships or grants________________ student loans________________ other (please specify)5. Are you a student member of the Texas Medical Association (TMA)? Yes No6. If no, since membership in TMA is a requirement for eligibility, is your membership pending? Yes No(There is no charge to become a student member of TMA. You can apply online at www.texmed.org.)By my signature below I certify that all the information I have provided on this application is true andcorrect. I further certify that I have read and will comply with the scholarship rules and regulations. Thissection must be completed.___________________________________________________signature_______________________date