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, 2018
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?
1-Yes
2-No
Full Name
Email
Phone Number
Age
Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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
1-Freshman
2-Sophomore
3-Junior
4-Senior
5-Graduate
College \ University
College\University - Address
College\University - City
College\University - State
College\University - Zip
Student ID Number
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
1-Yes - I am willing to do volunteer work, share my experience with young
patients with cancer and provide them emotional support and guidance.
2-No - I am not willing to do volunteer work. Explain:
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)
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 2016 or 2017 tax return if they file jointly
2. Your Father's and Mother's 2016 or 2017 individual return if they file separately
3. Your personal 2016 or 2017 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
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, 2018 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.
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