Lampe-Tillotson Physician Scholarship II

Lampe Foundation CFUW Sherbrooke & District in partnership with Tillotson Coaticook Regional Fund offers a scholarship to a local medical student who intends to practice in the Eastern Townships after graduation.

This scholarship is renewable. (maximum 4 years)

Priority will be given to students from MRC Coaticook, North Hatley, Stanstead, Ayers Cliff etc.

Preference to students enrolled in the Faculty of Medicine and Health Sciences at the University of Sherbrooke. Medical Residents are not eligible for this scholarship.

ELIGIBILITY CRITERIA

Full-time student
Canadian citizen or landed immigrant
Financial need
Bilingual

THE FOLLOWING DOCUMENTATION SHOULD ACCOMPANY THE COMPLETED FORM:

Copy of latest transcript
One signed letter of reference from a teacher or employer attesting to your potential to work in your chosen field and your language skill.
Note: This document can be sent directly via email to the foundation from the teacher or employer. This document may also be mailed via Canada Post directly to the Lampe Foundation. The address is on the form.
Proof of Canadian citizenship or Permanent Resident Status.
Proof of acceptance in a degree program

This award is contingent upon the applicant providing proof of registration and remaining in an accredited university program.

Decisions of the Scholarship Selection Committee are final.
All information will be treated in strictest confidence

Application Deadline

March 30

Award Amount

$5000

Full Name*
Prefix First Last
Present Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How many years at this address?*
Permanent Address
- Same as present address
*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How many years at this address?*
Home Phone Number*
Cell Phone Number
Email Address*
I am a:*
- Canadian Citizen
- Permanent Resident
High School Name*
High School Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Years Attended (YYYY-YYYY)*
Other Education*
Program name Program number Years (YY-YY)
Name and department of a professor who will recommend you for this prize.*
Name Department
Describe your intended course of study (institution, degree or diploma, field of study, length of program).*
Please explain your career goals:*
Describe your community involvement on campus:*
Describe your community involvement off campus:*
What other awards have you applied for, and have your applications been successful?*
Is there anything else you would like to tell us about yourself to help us select the successful applicant? This may include information about your personal circumstances.
Copy of proof of Canadian citizenship or Permanent Resident status*
This can be a copy of a passport, birth certificate, PR Card, etc.
We are currently only accepting PDF copies of the files.
Max file size: 2MB
Accepted file types: pdf, Max. file size: 100 MB.
Copy of latest transcript*
We are currently only accepting PDF copies of the files.
Max file size: 2MB
Accepted file types: pdf, Max. file size: 100 MB.
Copy of proof of acceptance in a degree program*
We are currently only accepting PDF copies of the files.
Max file size: 2MB
Accepted file types: pdf, Max. file size: 100 MB.
One signed letter of reference from a teacher or employer attesting to your potential to work in your chosen field and your language skill
We are currently only accepting PDF copies of the files.
Max file size: 2MB
NOTE: This document can be sent directly via email to the foundation from the teacher or employer.
Drop files here or

Accepted file types: pdf, Max. file size: 100 MB, Max. files: 2.
- Check this box if your teacher or employer will contact the foundation directly via email or if the document will be mailed.
Terms and agreement*
I certify that the information in this application is accurate and complete, to the best of my knowledge. If selected, I agree to have my name and place of study published on the CFUW Sherbrooke & District internet web site (cfuwsherbrooke.org),on Lampe Foundation website (www.lampefoundation.org) and on Lampe Foundation Facebook page.
- I agree to the terms and certify all all the above information is correct.
Name
This field is for validation purposes and should be left unchanged.