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Indiana University School of Medicine

Medical Student Portal

/ Support Services  /   Financial Aid  /   Application for Financial Assistance

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.

"*" indicates required fields

Demographics

Your Name*
Address*

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 upcoming academic year. Have you applied for the following opportunities?

One scholarship and amount per line

Scholarship Related Questions

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.

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 a military veteran?
Are you an Eagle Scout or Girls Scout Gold Award Recipient?
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?
Do you have a general intent to be a general practitioner?
Please answer yes or no for each question above.

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.

This field is for validation purposes and should be left unchanged.