Cancer Survivors' Fund

 

Scholarship Application

ACADEMIC YEAR - Indicate the academic year for which you are applying for scholarship assistance.

Freshman  Sophomore  Junior  Senior   

College/University: 

 

PERSONAL DATA

First Name

MI

 Last Name                                          DOB
 

           

Permanent Street Address Line 1 Permanent Street Address Line 2
City State Zip

Phone

Permanent e-mail

 

Street Address at School Line 1 Street Address at School Line 2
 
City State Zip

Cell Phone

e-mail at school

 

Describe yourself in one paragraph

 

Describe your family situation in one paragraph

 

    

 

  Yes. I am willing to do volunteer work, share my experience with young patients with cancer or other  medical challenges and provide them emotional support and guidance.

 

Have you previously performed volunteer work? If you did, please give details.

 

EDUCATION

High School

College/University for Academic Year Indicated

Location (City, State) Location (City, State)
High School GPA College GPA
             Major Subject Degree Expected Expected Year of Graduation (College)

 

 

 

 

MEDICAL INFORMATION 

    Yes. I have been diagnosed with cancer.

Name of your Attending Physician

Name and Location of Hospital

   

Type of Cancer

Age Diagnosed

   

 

FINANCIAL INFORMATION

 

Expected expenses for academic year indicated

List any other scholarship assistance applied for

Tuition, Fees and Books  

 

Room, Board & Transportation
Other
TOTAL  
Family Income (To be Verified)  

 

SUPPLEMENTAL INFORMATION

Please mail the following documentation to:

Cancer Survivors' Fund

P.O. Box 792, Missouri City, TX 77459

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Two (2) letters of recommendation from two different academic teachers addressing why you should receive this scholarship (make sure they are signed by the writer.) 

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

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

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A release from you, and your parents if you are a minor, that you agree to have your name and photo published in the news media or any CSF publication as a recipient of Cancer Survivors' Fund scholarship and that you agree to have your name, photo and your success story to be published on this website or in any CSF publication.

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A 2.5 x 3.5 portrait photo (no glamour shots please) if sending hard copy. Digital preferred.

Download Release
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Completed applications and supporting documents must be submitted (postmarked) by March 3rd to be considered for the 2017 Fall Semester.  

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Please DO NOT print and mail this application. Use the Submit Application button below.

 

THE ESSAY 

 

Submit an essay with this application. 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 1200 words. Essays may be entered in the box below or submitted separately, attached to an e-mail. Please DO NOT mail.

 

Last Name
 

 

 

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