The Association of Family Practice Physician Assistants is pleased to offer a scholarship award to two deserving students commemorating the life of AFPPA president Jim Meeks, who passed away on April 28, 2009.

This scholarship is funded annually by Dillehay Management Group in loving memory of our dear friend and mentor, Jim Meeks.  It is our privilege to honor his tremendous passion, spirit, and contributions to AFPPA and the entire physician assistant profession.

To apply for the Jim Meeks Memorial AFPPA Student Scholarship, you must complete the following steps:

• Submit an essay (750 words or less) that describes your commitment to family practice, rural health and education. Additionally, describe your efforts to support and promote the PA profession.
• Complete the registration form (below) and forward it to a faculty member at your school, along with your essay. The faculty member must then complete the faculty form, and forward everything from an official school e-mail address. (Only complete e-mail applications will be considered!)
• Your application is scored based on your essay and faculty recommendation.

Please note that all applications and attachments must be in Microsoft Word (or compatible format). PDF OR SCANNED DOCUMENTS WILL NOT BE CONSIDERED.

Deadline: September 1 (Late applications will not be considered.)

Award Amount: $1,500 per student

Faculty members should submit the complete application to:

Rene McCarty, PA-C
AFPPA Scholarship Committee Chair
scholarshipchair@afppa.org

(Copy and paste into an email below this line)_______________

Jim Meeks PA-C, DFAAPA Memorial AFPPA Student Scholarship Applicant Information:

Name: __________________________________________________

Address: ________________________________________________

_______________________________________________________

Phone: ________________ Email: __________________________

Name of PA Program: _____________________________________

AFPPA Membership Number: _______________

The COMPLETE application should be submitted by the faculty member by email to scholarshipchair@afppa.org

This page is to be completed by PA Program Faculty

Student´s Name: __________________________________________

PA Faculty Member´s Name: _______________________________

Faculty Phone/Contact Number: _____________________________

Program/University Name: _____________________________

Is this student in good academic standing? ___Yes ___ No?

Based on the criteria presented, what characteristics make this student outstanding in some way? Your comments and evaluation constitute 50% of the points for this student!