Medical RENEWAL - Crawford Heritage Community Foundation - Scholarship Application

MMC Medical Staff Memorial Scholarship
and Thomas M. Watson Memorial Scholarship Application
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 uploaded or postmarked (if mailed via US Mail) 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 can be submitted using any of the following methods: 
Upload:   Documents can be uploaded using the fields at the bottom of this application
Email:     Attach documents to an email addressed to, please indicate the                      applicant's name, high school and types of attachments in the body of the email.
US Mail:  Crawford Heritage Community Foundation 
              PO Box 933 
              Meadville, PA 16335-0933

Academic Information

List the name of the High School from which you graduated.

List the year you graduated from High School.

List the name of the College/University from which you received your undergraduate degree.

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

List the year in which you expect to graduate with your doctoral degree.
Supporting Documentation
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!

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.