Full Name* First Place of Birth*Year of Birth*Address* Street Address City State Zip Code Home PhoneMobile Phone*Your Email* Education*Undergraduate School*DegreeYearGraduate SchoolDegreeYearHellenicHellenic Describe Hellenic Descent*Describe your participation in the Hellenic community and list the Hellenic organizations that you have been involved in, if any:Desired Specialty, if anyMaterials to ProvideThe following materials must be submitted to the Scholarship Committee along with your Application:A. One letter of recommendation (can be one used for school)* (.pdf .doc .rtf files only)Max. file size: 128 MB.B. Transcripts of grades (can be unofficial transcript)* (.pdf jpg files only)B. Transcripts of grades (can be unofficial transcript)* (.pdf jpg files only)Max. file size: 128 MB.FileMax. file size: 128 MB.FileMax. file size: 128 MB.C. Photograph to accompany application (can be selfie) * (.png .jpeg .jpg .pdf files only)Max. file size: 128 MB.OathI pledge that the information that I have provided is accurate and true to the best of my knowledge. First time Applicant I pledge if awarded a HMSPHL Scholarship, I will;A. Contribute to the mission of HMSPHL; A. Contribute to the mission of HMSPHL;B. Once a graduate Medical, Allied Health school become a Member of HMSPHL via www.hmsphl.com and remain active in the organization in order to benefit future award recipients; B. Once a graduate Medical, Allied Health school become a Member of HMSPHL via www.hmsphl.com and remain active in the organization in order to benefit future award recipients;C. Recruit fellow Hellenes to join HMSPHL and support its mission C. Recruit fellow Hellenes to join HMSPHL and support its missionSince receiving my HMSPHL Scholarship I have contributed to the mission of HMSPHL by: (please check all that apply)Successfully recruiting fellow Hellene Doctors or Dentists to join HMSPHL;Names Names Submitted content for the HMSPHL website, E-Newsletter or Facebook page;Solicited donations to support HMSPHL events or its mission;Names of Donors:Volunteered my services to HMSPHL in another capacitySecond Time Applicant Second Time Applicant
