THE DR. JOE AND LYNN OUSLANDER SCHOLARSHIP IN ...

APPLICATION PROCESSPlease return the completed scholarship application:- By email to: mdfinancialaid@fau.edu- By fax to: (561) 297-2221- By mailing to:Attn: Marissa SmithCharles E. Schmidt College of MedicineFlorida Atlantic University777 Glades Rd.Bldg. 71, Room 310Boca Raton, FL 33431NOTIFICATION PROCESSApplicants will be notified of their award by an award acceptance letter.If you are offered a scholarship, you are required to submit the signed awardacceptance letter before funds will be applied to your account.For more information on the scholarship program please emailmdfinancialaid@fau.edu or call (561)-297-2591.SCHOLARSHIP RECIPIENT REQUIREMENTS (SCHOLARSHIP DONOR STEWARDSHIP)Participation in the annual FAU-wide Scholarship Luncheon which formallyconnects the Charles E. Schmidt College of Medicine scholarship donors, Dr. Joeand Mrs. Lynn Ouslander and scholarship recipients to have an opportunity to meetand have lunch in person.Scholarship recipients will write a hand written thank you cards, addressed,stamped and unsealed to Dr. Joe and Mrs. Lynn Ouslander. This must be submittedwith Award Acceptance Letter.Important: Please stamp your thank you cards, but leave unsealed as we needto make copies for our FAU files.Please use this Return Address:Your NameFAU Schmidt College of Medicine777 Glades Road, BC-71Boca Raton, FL 33431Addressee: (i.e.)Dr. Joe and Mrs. Lynn OuslanderWe will complete the rest of the address2

THE DR. JOE AND LYNN OUSLANDERSCHOLARSHIP IN GERIATRICS2012-2013APPLICATIONName:__________________________________________________FAU Student Z#___________________________________________AMCAS ID # _____________________________________________Home Address: _______________________________________________________(Number and Street)_______________________________________________________(City) (State) (Zip)E-Mail Address: _______________________________________________________Contact Phone Number: (______)___________-_________________Year of Study: □ M1 □ M2Residency Status: □ In-State □ Out-of-StateDid you qualify for a fee-waiver from AMCAS?□ Yes □ NoDid you identify yourself on your AMCAS application as having a disadvantaged background?□ Yes □ NoMay we publicly announce your name if you are a recipient?□ Yes □ NoRequirements:□ Personal Statement (attached)□ FAFSA SubmissionI authorize the release of this application and any relevant supporting information to persons involved in theselection of scholarship recipients.________________________________________Applicant’s Signature3_______________________Date