Women'sCancerCareFund

to support the growth and development of healthcare services around the world within underprivileged communities

International Medical Outreach Scholarship Application

We are excited to introduce a new scholarship for this spring designed to meet the needs of those students who wish to participate in the international medical experience with Womens Cancer Care and TeamCirisano. This scholarship is specifically designed for a medical student in their 3rd or 4th year of training, who wishes to contribute to the success of our outreach trip. The student selected for the scholarship will receive up to $5000 to cover transportation, room, board and essential expenses related to the specific international medicine relief trip. This scholarship comes at the request of so many students who desire to take international relief trips each year and are looking for another source of financial support while the cost of medical education continues to rise. We encourage anyone who may qualify to apply as soon as possible. Description of said years Outreach trip to include: Location Mission statement and objectives Sister Organization Travel dates Our next outreach to Peru will take place in July 2013 and will be collaborating with CerviCusco out of Cusco, Peru. CerviCusco is a Peruvian registered non-profit association dedicated to preventing cervical cancer. Established in 2006, CerviCusco is affiliated with the International Cervical Cancer (INCCA) Foundation, a non-profit (501c3) organization registered in the United States of America. CerviCusco is also supported by the Medical College of Georgia, Medical College of Georgia Research Institute and the Medical College of Georgia Foundation. Cervical cancer is the number one cause of cancer deaths in Peruvian women 15 to 64 years old with a very high relative rate of cervical cancer compared with other countries in the world. The majority of Peruvian women with cervical cancer are diagnosed at advanced stages when treatment options are limited and survival rates poor.The anticipated surgical program will include 15 major operations for gynecologic tumors and approximately 250 patient encounters in the outpatient center. Additional initiatives include administration of Human Papillomavirus Vaccinations in our efforts to assist with worldwide cancer prevention. The applications will be accepted on a rolling basis and the winner will be announced by April of the year in which the outreach will occur. The Award may only be applied towards the specific relief trips awarded. Scholarships will be awarded to the extent that funding permits. A student who wishes to apply must complete and submit all parts of the application to Womens Cancer Care by the submission deadline. Recipients will be selected at the discretion of the scholarship selection committee. Any questions should be brought to Womens Cancer Care and Team Cirisano.

E-Mail: teamcirisano@gmail.com Website: www.webteachmd.com

Women'sCancerCareFund
to support the growth and development of healthcare services around the world within underprivileged communities

Eligibility requirements: 1) Student must be in the third or fourth year of their medical training. 2) Student must have a strong interest in international medicine 3) Student must show competency or have completed a minimum of one core rotation in surgery and ob-gyn. 4) Once chosen for the scholarship, the recipient must work with Womens Cancer Care and Team Cirisano to further the humanitarian objectives of the organization.

Upon completion of the qualifying international experience, the recipient must complete the following:

1. An essay of 2000 words or less describing the students experiences during the trip.

This essay may be used on the Womens Cancer Care website to promote the International Health Scholarship program. 2. A completed reimbursement form with all original receipts, reflecting actual travel, room, board, and ancillary expenses. 3. Completion of public health needs assessment or data collection while on specified outreach trip. Submission Deadline: April 15, 2013 Please include the following in your scholarship application:
1. 2. 3. 4.

Application form (Section I) Essay response (Section II) Curriculum vitae Official Transcript electronic copy preferred

Application Requirements

Medical Student Not a previous recipient of the scholarship Completed application packet postmarked by the deadline date

Email completed applications to: teamcirisano@gmail.com Any parts of the application (i.e. transcript) that cannot be emailed may be sent to:For more information or questions regarding the scholarship, please
contact the Team Cirisano at teamcirisano@gmail.com

E-Mail: teamcirisano@gmail.com Website: www.webteachmd.com

Women'sCancerCareFund
to support the growth and development of healthcare services around the world within underprivileged communities

E-Mail: teamcirisano@gmail.com Website: www.webteachmd.com

Women'sCancerCareFund
to support the growth and development of healthcare services around the world within underprivileged communities

Section I:

Application form
Gende r

Scholarship Title Name of Applicant

Date of Birth Email address Mailing address State City Phone number Altern ate numb er Gradu ation yr ZIP code

Medical School Country of travel Hospital/Clinic/O rganization Name Contact Person Name Contact Phone/Email

Section II: Essay response Please answer the following questions on a separate sheet of paper, limiting their content to two pages total. Also, please make sure the name of the scholarship you are applying for is in the header of each page.
1. Please describe why this location appeals to you and why the specific population we

will be working with is of interest to you. Describe how you discovered this international opportunity. 2. Describe previous international/ medical experience the makes you an asset for the team and how you plan to contribute to the development of our humanitarian efforts. (please provide any ideas, personal projects that you would like to initiate.) E-Mail: teamcirisano@gmail.com Website: www.webteachmd.com

Women'sCancerCareFund
to support the growth and development of healthcare services around the world within underprivileged communities

3. State how this experience will benefit your education and future career as a physician. 4. Considering the expected expenses of this trip, describe your need and how this

scholarship would benefit you. Please be as specific as possible.

E-Mail: teamcirisano@gmail.com Website: www.webteachmd.com