Application for Financial Assistance

The form is a means for collecting information that is not available or collected through the FAFSA and the through the Admission’s process. Information is used to identify students who may be considered for IUSM scholarship with specific criteria.

  • Demographics

  • Your Name * Required
  • Address * Required
  • County and State

  • Our office communicates exclusively through e-mail. Please designate the e-mail address where you wish to receive important communications. We will later communicate through the IUSM Class lists constructed specifically for your class.
  • Scholarship Information

    If applicable, indicate if you have applied for and/or have been awarded any scholarships from outside the medical school or non-school organizations to be applied toward your medical school education for the 2018-2019 academic year. Have you applied for the following opportunities?

  • (e.g., church or fraternal organizations, community foundations)
  • YesNo
    As a graduate of Purdue University or Indiana University undergraduate, will you have been out of school for 2 or more years prior to attending medical school?
    Are you of Croatian Ancestry?
    Are you of Jordanian, Palestinian, Lebanese or Syrian descent?
    Are you LGBT?
    Have you demonstrated positive LGBT support through active membership in Gay Straight Alliances or affiliation with the Human Rights Campaign or other similar groups supportive of LGBT individuals?
    Do you have any physical disabilities?
    Are you a member of Delta Gamma or Phi Gamma Delta?
    Are you a member of the Lutheran Church Missouri Synod?
    Are you a resident of New Harmony Township in Posey County?
    Did you play Division I sports at Indiana University-Bloomington?
    Are your parents/grandparents wartime veterans (killed, wounded or served)?
    Are you married or will be married within the next two years?
    In some situations, IUSM scholarships have donor specificity where the information below will be needed and used in identifying scholarship eligibility or a pool of candidates.
  • Undergraduate or Non-Medical Graduate Loans

    List total amounts of any undergraduate or non-medical graduate educational loans disbursed to you BEFORE matriculating to the Indiana University School of Medicine. For a history of your Federal student loan information, use National Student Loan Data System (NSLDS) .

  • I affirm that the information submitted is complete and correct. I agree to report any additions or changes in this information to MSE-STUDENT FINANCIAL SERVICES.

    By entering my name below, I hereby give my permission to MSE-STUDENT FINANCIAL SERVICES to release information on this application, academic records, recommendations, and financial aid data to non-University groups for the purpose of additional financial aid or scholarship considerations.