Medical RENEWAL - Crawford Heritage Community Foundation - Scholarship Application
MMC Medical Staff Memorial Scholarship
Thomas M. Watson Memorial Scholarship
Complete applications are due to the Foundation no later than 5:00 PM on April 1. This form must be completed and supporting documents must be mailed by the deadline. If you have questions about the application process, please contact the Foundation by phone at 814-336-5206 or e-mail
Supporting documents should be mailed to:
Crawford Heritage Community Foundation
PO Box 933
Meadville, PA 16335-0933
Date of Birth
How long have you been a resident of Crawford County, Pennsylvania?
I am not a resident of Crawford County
Less than 1 year
More than 4 years
High School Attended
List the name of the High School from which you graduated.
High School Graduation Year
List the year you graduated from High School.
List the name of the College/University from which you received your undergraduate degree.
Undergraduate College/University Graduation Year
List the year you graduated from College/University.
Accredited Medical, Dental, Osteopathic or Podiatric school
List contact information for the institution where you will be studying in a program leading to a degree of doctor of medicine, dentistry, osteopathy or podiatry.
List the name of the educational institution you plan to attend.
List the name of your degree program or field in which you plan to study. You may list that you are undecided if you have not yet made a decision.
What is the estimated amount of tuition and fees to attend the educational institution for one year?
What is the estimated amount of room and board at the educational institution for one year
Anticipated Year of Graduation
List the year in which you expect to graduate with your doctoral degree.
The following supporting documents must be submitted to the Foundation in order for your application to be considered. Incomplete applications will not be considered.
Please mark out ALL social security numbers listed on submitted forms
to help ensure the security of your and your parents’ identities!
I attest that I have requested an Official Transcript be sent from my current or most recent educational institution to the Foundation.
I am unable to provide an Official Transcript. (Failure to provide a transcript may result in your application not being considered.)
You are responsible for having a copy of your official high school transcript submitted to the Foundation by the appropriate school personnel. The transcript should cover the first three and one half years of high school through the end of the Fall term of your Senior year. (Unofficial transcripts will not be accepted.) It should include a list of courses you have taken and the grade received in each course, your class rank and SAT® scores.
I hereby authorize the Crawford Heritage Community Foundation to request from any school attended by me: information, transcripts, financial aid records and any other records deemed necessary for the administration of these scholarship programs, and I authorize any such school to submit any information, transcripts and other records that may be requested by the Foundation.
Penalty of Perjury Statement
I declare under penalty of perjury, under the laws of the United States of America, that all statements contained in this application and any accompanying documents are true and correct, with full knowledge that all statements made in this application are subject to investigation and that any false or dishonest answer to any question may be grounds for denial or subsequent revocation of a scholarship.
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