VHF Lyman Fisher Scholarship Application

Step 1 of 2

In order to be considered for this scholarship you must submit a complete application by the deadline: 11:59 pm, Friday, April 30, 2021. Applications and/or supporting documents received after April 30 will not be considered.

For Questions contact the Virginia Hemophilia Foundation (VHF) at 804-740-8643 or info@vahemophilia.org

PLEASE NOTE: YOU CANNOT SAVE THIS FORM AND FINISH LATER - PLEASE ALLOW YOURSELF ENOUGH TIME TO COMPLETE THIS APPLICATION IN ONE SITTING. REVIEW THE CHECKLIST BELOW TO CONFIRM THAT YOU ARE PREPARED BEFORE YOU BEGIN. *

I understand that I cannot save this form and must complete and submit in one sitting.

CHECKLIST: *

BIOGRAPHICAL SKETCH: Please give a brief biographical sketch of yourself. Include your interests, hobbies, vocational and educational goals, volunteerism and community involvement, work or internship experience and anything else you think is important for the screening committee to know about you.

FINANCIAL STATEMENT: Please provide us with a detailed statement of financial need. Include the cost of tuition, books, supplies, room and board, and transportation for each semester. Include the sources and financial amount you expect to receive for your college education (i.e. parents and family, yourself, college and state grants, scholarships, etc.)

NARRATIVE ESSAY: Please include a narrative essay, which should include: a. How the scholarship will help you achieve your academic goals b. Your previous participation with the chapter and what you have done to contribute to the bleeding disorders community AND how you plan to contribute to VHF and the bleeding disorders community in the future c. Any other pertinent information you would like to share with the chapter

LETTERS OF RECOMMENDATION: Please provide letters of recommendation from at least two persons who are not family members but who know you well. One letter of recommendation should be from an HTC provider, nurse, social worker, or someone who knows you well from the bleeding disorders community. The other letter could be from your scout leader, minister, teacher, employer, guidance counselor, coach, etc. *These can either be attached to this application or emailed separately to info@vahemophilia.org by the April 30th deadline*

Applicants Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Email *

What university, college or vocational school will you be attending? *

What is your major and/or field of interest? *

If you answered "other", please explain:

What is your GPA? *

What is your class ranking? *

What was your SAT score? *

Do you have a bleeding disorder? *

If you answered no, please explain your relationship to the bleeding disorder community

If you answered yes, what bleeding disorder do you have?

What is the severity of your bleeding disorder?

What is the name of your Hemophilia Treatment Center (HTC) and/or Hematologist?

Please give a brief biographical sketch of yourself. Include your interests, hobbies, vocational and educational goals, volunteerism and community involvement, work or internship experience and anything else you think is important for the screening committee to know about you. *If you prefer to upload a separate document with this information write n/a in the text box and use the File Upload below* *

Biographical Sketch File Upload

Click or drag a file to this area to upload.

Please provide us with a detailed statement of financial need. Include the cost of tuition, books, supplies, room and board, and transportation for each semester. Include the sources and financial amount you expect to receive for your college education (i.e. parents and family, yourself, college and state grants, scholarships, etc.) *If you prefer to upload a separate document with this information write n/a in the text box and use the File Upload below* *

Statement of Financial Need File Upload

Click or drag a file to this area to upload.

Narrative Essay - Part A: How will the scholarship help you achieve your academic goals? *If you prefer to upload a separate document with this information write n/a in the text box and use the File Upload below* *

Narrative Essay File Upload

Click or drag a file to this area to upload.

Narrative Essay - Part B: What is your participation with VHF and what have you done to contribute to the bleeding disorders community AND how do you plan to contribute to VHF and the bleeding disorders community in the future? *If you prefer to upload a separate document with this information write n/a in the text box and use the File Upload below* *

Narrative Essay File Upload

Click or drag a file to this area to upload.

Narrative Essay - Part C: Any other pertinent information you would like to share with the chapter? *

Narrative Essay File Upload

Click or drag a file to this area to upload.

LETTERS OF RECOMMENDATION - LETTERS CAN BE UPLOADED OR EMAILED SEPERATELY

Letters of recommendation should come from at least two persons who are not family members but who know you well. These can either be uploaded to this application below or emailed separately to info@vahemophilia.org by the April 30th deadline. One letter of recommendation should be from an HTC provider, nurse, social worker, or someone who knows you well from the bleeding disorders community. The other letter could be from your scout leader, minister, teacher, employer, guidance counselor, coach, etc.

Name *

First

Last

Relationship to Applicant *

Upload Letter of Recommendation #1 - upload here or email a copy to info@vahemophilia.org:

Click or drag a file to this area to upload.

Name *

First

Last

Relationship to Applicant *

Upload Letter of Recommendation #2- upload here or email a copy to info@vahemophilia.org: :

Click or drag a file to this area to upload.

Declaration of Application: Do you certify that the information you have submitted is true and accurate to the best of your knowledge and that disclosing false information may jeopardize your award at any time?

Yes, I certify that the information I have submitted is true.

Name

In order to be considered for this scholarship you must submit a complete application by the deadline: 11:59 pm, Friday, April 30, 2021. Applications and/or supporting documents received after April 30 will not be considered.

For Questions contact the Virginia Hemophilia Foundation (VHF) at 804-740-8643 or info@vahemophilia.org

LETTERS OF RECOMMENDATION - LETTERS CAN BE UPLOADED OR EMAILED SEPERATELY

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