Moebius Syndrome Foundation Educational Scholarship Application

Next spring the Moebius Syndrome Foundation will award four educational scholarships of $3,000 each, to individuals who have Moebius syndrome and will be attending an undergraduate college/university/post-secondary vocational school.

Three scholarships will be awarded to undergraduates and one to a graduate student!

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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