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2025 FMAS Scholarship Application Form

AAFP

Application for the 2025 Family Medicine Advocacy Summit - Student & Resident Scholarship

Thank you for your interest in applying for the 2025 Family Medicine Advocacy Summit Student & Resident Scholarship. Please complete the application items below and upload your most recent Curriculum Vitae (CV) as a .doc, .docx, or .pdf. Once you submit your application you will receive a confirmation email to the address you provided in the application.

Contact Information

1. First Name: *This question is required.

2. Last Name: *This question is required.

3. Email address: *This question is required.

4. Best phone number to reach you: *This question is required.

5. Address: *This question is required.

6. City, State, Zip: *This question is required.

7. Which of the following best describes you? *This question is required.

8. Are you an American Academy of Family Physicians (AAFP) member? *This question is required.

Please enter an 'other' value for this selection.

9. Are you active in health policy activities with your state chapter? *This question is required.

10. What legislative issues do you believe most affect family physicians? *This question is required.

11. What do you hope to gain by attending the Family Medicine Advocacy Summit? *This question is required.

12. How did you learn about this scholarship opportunity? *This question is required.

13. Please upload your most recent curriculum vitae (CV) in one of the following file formats (.doc, .docx, .pdf). *This question is required.

File: {{filename}} delete

14. Please provide any additional information you would like us to consider.