AMA Indigenous Medical Scholarship Application

Personal Details

First Name

Middle/Other Names

Surname

Date of Birth

Preferred Pronoun

Contact Details

Email address

Mobile phone number

Home phone number

Street Address

Suburb

State

Post Code

Attachments

Personal Statement

A 500-word statement answering the following topics:

The statement provided by the applicant clearly articulates their aspirations and purpose for studying.
The statement provided by the applicant thoughtfully describes the use(s) to which they hope to put their medical training.
The statement provided by the applicant adequately explains the way in which the scholarship finances would be used by the applicant to aide their study.
The statement provided by the applicant adequately explains the way in which the scholarship finances would be used by the applicant to aide their study.

(maximum 500 words)

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Curriculum vitae

Please attach a short curriculum vitae and the names and contact details of two referees (maximum two pages)
One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Supporting letter

Please attach an official letter from an Aboriginal and/or Torres Strait Islander community organisation (to which you are well known) supporting your application as an Aboriginal and/or Torres Strait Islander person
One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Academic record

Please attach an official transcript or letter from your university confirming your academic results for your first year of medicine, and any subsequent year of medicine completed.
One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Proof of enrolment

Please attach formal proof of full-time enrolment in a medical course for the 2021 academic year. This must be either an academic transcript or an official letter from the university. Screen shots will NOT be accepted.
One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

References

Please attach 2 reports from referees familiar with you giving strong evidence of your contributions, community connection and future potential
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Enrolment Information

University at which studies are being undertaken

Title of Course

Year Commenced

Current Year of Study

Declaration

I declare that the information I have provided is true and correct to the best of my knowledge. I understand that providing false or misleading information, or omitting relevant information, may lead to my application not being considered, or if I am awarded an AMA Indigenous Medical Scholarship it may be suspended, withheld, or terminated, at any time.

Declaration

Signature

Signature Date

I would like to be contacted about AIDA Student Membership

I acknowledge that by ticking I am giving permission for the AMA to provide my contact details to AIDA for the purpose of them contacting me with membership information.

I would like to be contacted about AMA Student Membership

I acknowledge that by ticking I am giving permission for the AMA to provide my contact details to my state AMA for the purpose of them contacting me with membership information.

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Personal Details

Contact Details

Attachments

Attachments

Attachments

Enrolment Information

Declaration

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