Scholarship test page

Educational Scholarship Application

Name
First Last
Email
Phone
Student I.D.
Date of birth
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
All applicants must have 2–3 years of work or volunteer experience
Volunteer/Community activities with dates included.
Employment (List all jobs you've had in the last 3 years and the number of hours worked per week and dates of employment. If you have not worked anywhere, type N/A.)
Hobbies/Interests
Estimate education costs for the next academic year
Tuition/Fees
Room & board
Books/Supplies
Have you previously been awarded an education scholarship from the Moebius Syndrome Foundation? Note: Applicants that were previously awarded are still eligible to apply.*
- Yes
- No
File Upload Instructions
Upload the following files: (1) a one-page essay in PDF format on why you should receive this scholarship; (2) two to three letters of reference from teachers, employers, etc.; (3) a transcript from your high school or college/university/post-secondary institution; (4) a recent photo—300 ppi or more).

Essay must be TYPED and in PDF format. No handwritten submissions are acceptable. No exceptions.

Transcript must be a PDF or other readable file format with the accredited college info listed—no screenshots, camera images or otherwise acceptable.

Letters of Rec—minimum of 2–3 letters preferred. Must be signed and approved by a professional instructor or personal reference. References from family members are not acceptable.

Photos—high-quality headshots (300 PPI or more) ONLY. Must either be a high-resolution senior photo (can have black background or otherwise) or other nice quality photo. No selfies.

Submitted docs—MUST upload all documents either at the time of original submission or within 1 week of submission—no exceptions. Not following the instructions given means a declined application. Not submitting on time means declined as well.
These files can also be emailed directly to tara@moebiussyndrome.org. Please label each file with your name for easy identification.
Drop files here or

Max. file size: 20 MB, Max. files: 5.
These files can also be emailed directly to tara@moebiussyndrome.org. 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)*
Your Name
Your Name
Your Name
Date

Educational Scholarship Application

All applicants must have 2–3 years of work or volunteer experience

Estimate education costs for the next academic year

File Upload Instructions