Nathan Deal Scholarship Application

Name*

First Last

Preferred Name*

Date of Birth*

Primary Email Address*

Alternate Email Address

Cellphone Number*

Date of Acceptance (MM/YYYY)

For recently accepted students

Expected Date of Graduation from MUSM (MM/YYYY)

For enrolled medical students

MUSM Location (current or will attend)

Current Residence*

Street Address Address Line 2 City State ZIP Code

Permanent Home Address*

Street Address Address Line 2 City State ZIP Code

County of Residence*

Name of High School Attended*

Town, County and State of High School Attended*

Name of College/University Attended (Undergrad)*

Undergraduate Degree & Major*

Example: B.S., Biology

Month & Year Undergraduate Degree Received*

List all cities/counties, states where you have resided since birth. Include dates (MM/YYYY) of residency.*

Example: Tifton, GA (04/1992-07/2010); Athens, GA (08/2010-05/2014); Tifton, GA (05/2014-date)

What city do you consider to be your hometown?*

Speciality of Interest*

Check all that apply

Family Medicine
General Internal Medicine
General Pedicatrics
Obstetrics and Gynecology
Psychiatry
General Surgery

Describe your rural life experiences and desire to reside in a rural Georgia county.*

What are your career plans?*

What are your thoughts on the attributes needed to become a successful rural physician and the role that a physician plays in a rural community?*

Describe any experiences or interest that you may have regarding rural health policy and physician leadership development.*

What attributes do you possess that make you a top candidate for the Nathan Deal Scholarship?*

Service Commitment

By submitting this application, I understand that if I am awarded this scholarship, I will be required to work AND reside in a Georgia county with a population of 50,000 or less, as approved by the School of Medicine, for a minimum of four years.

2025 Nathan Deal Scholarship Application