Snowdrop Scholarship Application

Thank you for your interest in applying for a scholarship from Snowdrop Foundation. Although all applications will be considered for funding from Snowdrop Foundation, we are not currently able to provide scholarships for all requests. If you are not selected for a scholarship during this application period, Snowdrop Foundation will keep your original application on file.

Applications will only be considered for review if they are completed in full.
DUE APRIL 30, 2019

Please note that all scholarships will be paid to the third party designated on your
application form. No scholarship monies will be paid directly to recipients.

If you are chosen as a recipient, Snowdrop Foundation must receive all necessary paperwork (including receipts, invoices, bills, and anything else requested by Snowdrop Foundation) from you within one week of notification. If you are unable to provide the paperwork in a timely manner, your scholarship may be revoked.

It is the policy of Snowdrop Foundation not to discriminate, in its consideration of scholarship applications and in its awarding of scholarships, on the basis of race, color, religion, gender, national or ethnic origin, disability, or sexual preference.

If you have questions regarding the completion of this application, please direct them to Trish Kline, trish@snowdropfoundation.org 713-232-9051

** Snowdrop Foundation reserves the right to contact you if further information is needed for consideration of your application for a scholarship.

Application Form

Are you a returning applicant?*

Full Name*

Email*

Phone Number*

Age*

Address*

City*

State*

Zip*

Social Security Number

Scholarship Specific Information

Grant & Scholarship Request*
By checking the box below, I understand that if I am selected as a recipient of a scholarship from Snowdrop Foundation, all funds will be distributed to the third-party payees that I have designated, and that no scholarship funds will be paid directly to me.

Academic Year*

College \ University*

College\University - Address*

College\University - City*

College\University - State*

College\University - Zip*

Student ID Number*
If you don't have your student ID Number yet Enter N/A

Personal Narrative

Describe Yourself In One Paragraph*
Please limit yourself to 250 OR LESS for the following:

Describe Your Family Situation In One Paragraph*
Please limit yourself to 250 OR LESS for the following:

Volunteering Initiatives

Volunteer Work*

Volunteer Work (If No - please explain)

Have you volunteered before? If yes, give details

Education

High School*

High School Location (City, State)

College/University Attending for Academic Year*

College/University Attending Location (City,State)*

Select the GPA scale of your educational facility*

High School GPA

College GPA

Major Subject

Degree Expected
(B.S., B.A., etc)

Expected Year of Graduation

Medical Information

Yes, I have been diagnosed with cancer*

Name of Your Attending Physician*

Name and Location of Hospital*

Diagnosis*

Age at Diagnosis*

Financial Information
Expected Expenses for Academic Year Indicated:

Tuition, Fees and Books*

Room, Board & Transportation*

Other

Total*

Annual Income*

Income and Supplemental Information
ATTACH ALL FILES HERE
Maximum allowed attachments = 10

INCOME
The first two pages of the most current tax return (Please provide all that apply)

1. Your parents 2017 or 2018 tax return if they file jointly

2. Your Father's and Mother's 2017 or 2018 individual return if they file separately

3. Your personal 2017 or 2018 tax return

4. If you do not file a tax return, you must show proof of any income such as SSI, W-2, Snap Benefits or other written documentation

SUPPLEMENTAL INFORMATION
1. Two (2) letters of recommendation from two different academic teachers addressing why you should receive this scholarship [If you are a returning scholarship recipient you do not need letters]

2. A letter from your attending physician verifying your medical history and current medical situation

3. A copy of an acceptance letter from the college/university of your choice or a letter of good standing from the registrar

4. One year of Academic Transcripts (High School, College or Combination depending on your year in school)

5. Applicant portrait picture

Completed applications and supporting documents must be submitted by April 30, 2019 of application year to be considered for the Fall Semester. Late applications will not be considered.

ALL INCOME & SUPPLEMENTAL INFORMATION ATTACH HERE*
Please note, this web form allows for a maximum of 10 attachments.

List Any Other Scholarship Assistance Applied for
If you have received a scholarship please make a note of amount.

Release
Snowdrop Foundation A Non-Profit, Tax-Exempt, Publicly Supported Organization with IRS 501(c)(3) status. EIN 20-4478536

As the recipient of Snowdrop Foundation’s Scholarship, I agree to have my name and photo published in the news media and my name, photo and success story to be published on www.snowdropfoundation.org website, newsletters, brochures, speeches or any other promotional material.

Applicant Name*

Applicant Signature*

Applicant's Date*

If Applicant is a Minor
As the parent/guardian of the applicant I agree that if he/she is the recipient of the scholarship that his/her name and photo may be published in the news media and his/her name, photo and success story to be published on www.snowdropfoundation.org website, newsletters, brochures, speeches or any other promotional material.

Parent\Guardian Name

Parent\Guardian Signature

Parent\Guardian Date

The Essay*
Discuss the following question. HOW HAS MY EXPERIENCE WITH CANCER IMPACTED MY LIFE VALUES AND CAREER GOALS? Essays must be a minimum of 500 words and a maximum of 1000 words.

Confidentiality Statement
Snowdrop Foundation is committed to maintaining the confidentiality of the medical information, financial information, and other personal information and data that you provide to us. Snowdrop Foundation understands and acknowledges that you have reposed trust in us to protect the confidentiality and security of all of that information and data.

The information and data that you provide to Snowdrop Foundation will remain your information and data. Snowdrop Foundation will not use your information and data for purposes other than those purposes for which you provide such information and data to us or for which you otherwise authorize Snowdrop Foundation, in writing, to use such information and data.

Snowdrop Foundation will not sell, or otherwise disseminate or make available to third parties the information and data that you provide, in whole or in part. Snowdrop Foundation will restrict access to the information and data that you provide to those persons who will evaluate your information and data for purposes of determining your eligibility for, and making awards of, the financial assistance that Snowdrop Foundation provides.

Snowdrop Foundation will not disclose your information and data to any third party unless the disclosure is authorized by you in writing or is compelled by an order of a court, administrative agency, or other governmental body. Snowdrop Foundation will comply with any such order only after providing you with notice of such order so that you have the opportunity to seek a protective order or other restriction on the disclosure of your information and data.

Send me a copy of my responses

Email address