Medical School Loan Forgiveness Funds

Please select the scholarship fund you are applying for:(Required)

Joe and Cheri Natcher Medical Education Endowment Fund

Medical School Loan Forgiveness Fund

A. Applicant Information

Full Name(Required)

Prefix First Middle Last Suffix

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

B. Scholarship-Specific Requirements

Select at least one of the scholarship funds in order to see their related requirements. Applicants must meet all applicable scholarship requirements in order for their application to be considered.

Year of Graduation from Western Kentucky University(Required)

Year of Graduation from UK College of Medicine(Required)

Start Date(Required)

Location(Required)

Position/Specialty(Required)

C. Graduate Medical Education

Please provide information about your residency and fellowship training programs.

Residency Program

Residency Program(Required)

Residency Location(Required)

Residency Completion Year(Required)

Fellowship Program

Have you completed or are you currently enrolled in a fellowship program?(Required)

Yes

Fellowship Program(Required)

Fellowship Location(Required)

Fellowship Completion Year(Required)

D. Educational Debt Summary

Please provide information about each medical education loan separately. Loans with the same servicer and repayment terms may be grouped together.

Total Current Medical Education Debt(Required)

Enter the current total balance of all medical education loans combined, including federal, private, and institutional loans.

Medical Education Loan 1

Loan Type(Required)

Loan Type Other

Loan Repayment Status(Required)

Examples: Standard Repayment, SAVE, PAYE, IBR, deferment, forbearance, residency deferment, or not yet in repayment.

Loan Repayment Status Other

Loan Monthly Payment(Required)

Enter the current required monthly payment amount for this loan.

Do you need to add another medical education loan?

Yes

Medical Education Loan 2

Loan Type(Required)

Loan Type Other

Repayment Status(Required)

Examples: Standard Repayment, SAVE, PAYE, IBR, deferment, forbearance, residency deferment, or not yet in repayment.

Repayment Status Other

Monthly Payment(Required)

Enter the current required monthly payment amount for this loan.

Additional Educational Debt Information

Educational Debt Summary Notes

Include any additional context that may help reviewers understand your educational debt, repayment obligations, financial hardship, or forgiveness arrangements.

Supporting Documentation

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 2 MB, Max. files: 10.

Optional: Upload supporting loan or repayment documentation if it may help reviewers better understand your educational debt situation.

E. Loan Assistance Disclosures

Please disclose any current educational loan repayment or forgiveness assistance arrangements you are receiving.

I am currently receiving educational loan repayment or forgiveness assistance.(Required)

Yes

Loan Assistance Disclosure 1

Source(Required)

Source Other

Program or Agreement Name

Enter the name of the repayment, forgiveness, or assistance program, if known.

Total Assistance Amount

Enter the total repayment or forgiveness assistance amount associated with this arrangement, if known.

Number of Years

Enter the total duration of the repayment or forgiveness arrangement in years, if known.

Do you need to add another loan assistance source?

Yes

Loan Assistance Disclosure 2

Source(Required)

Source Other

Program or Agreement Name

Enter the name of the repayment, forgiveness, or assistance program, if known.

Total Assistance Amount

Enter the total repayment or forgiveness assistance amount associated with this arrangement, if known.

Number of Years

Enter the total duration of the repayment or forgiveness arrangement in years, if known.

Additional Loan Assistance Disclosure Information

Loan Assistance Disclosure Notes

Include any additional context that may help reviewers understand your loan repayment or forgiveness assistance arrangements, service obligations, eligibility requirements, pending approvals, or related financial circumstances.

F. Personal Statement

Personal Statement Upload(Required)

Accepted file types: doc, docx, pdf, Max. file size: 2 MB.

Please attach a brief statement (1–2 pages) addressing the following: • Your connection to the region • Your commitment to practicing within Med Center Health • Your career goals • How this scholarship will impact your ability to serve patients

Medical School Loan Forgiveness Funds

Medical Education Scholarship Application

A. Applicant Information

B. Scholarship-Specific Requirements

C. Graduate Medical Education

Residency Program

Fellowship Program

D. Educational Debt Summary

Medical Education Loan 1

Medical Education Loan 2

Additional Educational Debt Information

E. Loan Assistance Disclosures

Loan Assistance Disclosure 1

Loan Assistance Disclosure 2

Additional Loan Assistance Disclosure Information

F. Personal Statement

G. Certification

Endowments created to fund Medical School Loan Forgiveness