Emory University Physician Assistant Program
                      Veteran Student Scholarship Application



Applicant Na...
Applicant Name: _______________________
Veteran Student Scholarship Narrative:

Describe your plans for giving back or “pa...
Emory University Physician Assistant Program

Statement of Good Standing Form (for current Emory PA students)


 _________...
Application process:

The application form and instructions are available to download on the Emory PA
Program web page, or...
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Emory University Physician Assistant Program

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Emory University Physician Assistant Program

  1. 1. Emory University Physician Assistant Program Veteran Student Scholarship Application Applicant Name: __________________________________________ Current Address: __________________________________________ ___________________________________________ ___________________________________________ Contact Phone Numbers: __________________________ (home) __________________________ (work) __________________________ (mobile/cell) E-mail address: ____________________________________ Social Security Number: _______________________________ Military field: ___________________________ (specify service arm) Date(s) of service: ___________________________ Emory University is dedicated to providing equal opportunities to all individuals regardless of race, color, religion, ethnic or national origin, gender, age, disability, sexual orientation, veteran’s status, or any factor that is a prohibited consideration under applicable law. Emory University does not discriminate in admissions, educational programs, or employment on the basis of any factor outlined above or prohibited under applicable law. Students, faculty, and staff are assured of participation in University programs and in the use of facilities without such discrimination. Required attestation: I attest that the information on this application is accurate. __________________________________________. Applicant signature
  2. 2. Applicant Name: _______________________ Veteran Student Scholarship Narrative: Describe your plans for giving back or “paying it forward” to model and encourage servant leadership on this page.
  3. 3. Emory University Physician Assistant Program Statement of Good Standing Form (for current Emory PA students) ___________________ (Student Name) is currently enrolled in the Emory University Physician Assistant Program and is in good standing academically and professionally. ______________________________________ _________________________ ____ Emory PA Program Division Director (print name) signature date
  4. 4. Application process: The application form and instructions are available to download on the Emory PA Program web page, or by contacting the Emory PA Program Office of Admissions (404 727-3027 or 7857). The completed application and required materials must be received by July 16th , 2007 at the Emory PA Program Office . The application packet should be sent to: Emory University Physician Assistant Program Veteran Student Scholarship Program 1462 Clifton Rd., Suite 280 Atlanta, Georgia 30322 Attn: Terry Mize or Kaye Johnson A completed application packet consists of: □ Application □ Documentation of Emory PA Program acceptance or current enrollment □ Documentation of veteran status and honorable discharge □ Form: Assurance of good standing signed by the Director of the Emory PA Program (if current student) □ One page narrative describing the applicants plans for giving back or “paying it forward” to model and encourage servant leadership.

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