Riverside County
Physicians' Memorial Foundation

The Physicians Memorial Foundation is a private foundation exempt from federal income taxes under 501 (c)(3).

Its primary purpose is to engage in activities of a charitable and benevolent nature. Activities shall include, but are not limited to, 1) receive donations and contributions which will assist the immediate families of deceased physicians who are found to be in need; 2) provide scholarship grants for pre-medical and medical students in Riverside County who are in financial need of assistance; 3) establish proper commemorative programs; 4) borrow money, executive notes, mortgages, trust deeds, and to deposit and invest funds received to the full advantage of the foundation; 5) carry on any activity to promote the interests of the foundation in connection with any of the foregoing purposes.

The Memorial Foundation currently has two programs in existence. The first is the scholarship grant. To qualify for scholarships, medical students must be a United States citizen and a resident of Riverside County for at least a 5-year period, be accepted or presently attending an accredited medical or osteopathic school, show financial need, and complete an application for scholarship assistance.

The second program is Project K.I.N.D. This program was created to provide free health care to children with acute illnesses who do not qualify for Medi-Cal and who have no health insurance. Project K.I.N.D. is dependant upon donations from community support, such as service organizations, health care agencies, and business foundations, and various grant opportunities.

To download a Donation Form, click here.

Riverside County Physicians Memorial Foundation
3993 Jurupa Avenue
Riverside California 92506
951-686-3343
FAX# 951-686-1692

*** APPLICATION FOR SCHOLARSHIP ASSISTANCE ***

This form may be downloaded to your printer and submitted via fax or regular mail. You may also request this application be sent to you by contacting Jeanne Vale at the Riverside County Medical Association.

Date:_____________________________________

Name:_________________________________________________________

Current Address:_________________________________________________

__________________________________________________

Current Phone#:_________________________

Date of Birth:_______________________________

Place of Birth:______________________________

Riverside County Resident:__________(years)_____________(months)

Sex:______________Age:_______________Marital Status:_______________

Citizenship:_________________________

Parent(s) Name:__________________________________________________

Parent(s) Address:_______________________________________________

________________________________________________

Parent(s) Phone#:___________________________________

Number of Siblings in your Family:________________

Ages:________________________________________________

To what school(s) have you been accepted?
What school do you plan to attend?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Approximate Grade Point Average:_______________

Give a clear picture of your financial position. Indicate what percentage of support you can count on from any and all sources (parents, school, etc.). What amount of aid would you require and for how long?

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

List Interests, extracurricular activities, honors won:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Names, addresses, and phone numbers of two character references. One reference should be a Riverside County Physician or one of your professors in undergraduate training___________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Write a short statement on a separate sheet of paper stating your reasons for wanting to study medicine. You may wish to include your Association of American Medical Colleges Application Form.

Please include a current picture of yourself.

__________________________________________Signature