Children's Healthcare of Atlanta Rural Pediatric Scholarship Application

2027-28 Children's Healthcare of Atlanta Rural Pediatric Scholarship Application

Deadline to apply: March 12, 2027

Company

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Preferred Name(Required)

Date of Birth(Required)

Primary Email Address(Required)

Alternate Email Address

Cellphone Number(Required)

Date of Acceptance (MM/YYYY)

For students recently accepted to MUSM

Expected Date of Graduation (MM/YYYY)

For currently enrolled Mercer medical students

MUSM Location

Current or will attend

Current Residence(Required)

Street Address Address Line 2 City State ZIP Code

County of Residence(Required)

How long have you lived in your current county?(Required)

Name of High School Attended(Required)

Town, County and State of High School Attended(Required)

Name of College/University Attended (Undergrad)(Required)

Town, County and State of College/University Attended (Undergrad)(Required)

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

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?(Required)

Do you plan to return to your hometown to practice? If not, where would you like to practice?(Required)

Describe your rural life experiences and desire to reside in a rural Georgia county.(Required)

What are your career plans?(Required)

What are your thoughts on the attributes needed to become a successful rural pediatrician and the role that a pediatrician plays in a rural community?(Required)

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

What attributes do you possess that make you a top candidate for the Rural Pediatric Scholarship?(Required)