Moebius Syndrome Foundation Educational Scholarship Application

In early May of 2023, the Moebius Syndrome Foundation will award up to five educational scholarships of $3,000 each, to individuals who have Moebius syndrome and will be attending an undergraduate college/university/post-secondary, trade or vocational school. Three scholarships will be awarded to undergraduates and up to two to graduate students.

Applicants must be currently enrolled or accepted into a school for the next open term to be eligible. Applicants must also reside in the United States or Canada to apply.

The enrollment period will open on January 16, 2023 and close on April 30, 2023.

Please be as detailed as possible, and submit all requested forms with your applications. If you have any questions, please contact us.

The application period opens on January 16, 2023. The deadline to submit your application is April 30, 2023. Applicants must reside in either the United States or Canada to be eligible.

Educational Scholarship Application

Name
First Last
Email
Phone
Student I.D.
Date of birth
MM slash DD slash YYYY
Home address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Post-secondary institution at which you are enrolled or have been accepted
Post-secondary institution address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Major
List honors/distinctions you have received
Career intentions
Volunteer/Community activities
Hobbies/Interests
Employment (List all jobs you've had in the last 3 years and the number of hours worked per week.)
Estimate education costs for the next academic year
Tuition/Fees
Room & board
Books/Supplies
Upload the following files: (• a one page essay on why you should receive this scholarship; • two letters of reference from teachers, employers, etc.; • a transcript from your high school or college/university/post-secondary institution; • a recent photo)
Drop files here or

Max. file size: 20 MB, Max. files: 5.
These files can also be emailed directly to ksmant@gmail.com. Please label each file with your name for easy identification.
Acknowledgement*
- I attest that all information submitted is true and accurate. I understand that if I am granted a scholarship I will permit my name and photograph to be used for publicity to further the mission of the Moebius Syndrome Foundation. I understand that this scholarship is competitive and there is no guarantee that I will receive an award.
Signature (or guardian if under 18 years of age)*
Date
MM slash DD slash YYYY

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Moebius Syndrome Foundation

info@moebiussyndrome.org

Educational Scholarship Application

Estimate education costs for the next academic year

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