RIAFP Foundation Scholarship Application

Thank you for your interest in receiving a scholarship through the RIAFP! Please fill out the information below to be considered.

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* 1. AAFP Member ID

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* 2. Please enter your contact information:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 3. Year of Medical School:

MS1

MS2

MS3

MS4

N/A

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* 4. Year of Residency:

PGY1

PGY2

PGY3

Other

N/A

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* 5. If applicable, have you applied for other scholarships from RIAFP? If yes, please describe.

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* 6. Please tell us why you are applying for a scholarship from RIAFP?

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* 7. Do you identify as underrepresented in medicine (URiM)? URiM refers to any identities that are traditionally and historically underrepresented in the field of medicine relative to their numbers in the general population?

Yes

No