VHF Terry Lamb Enrichment Scholarship

If you have questions about this scholarship (application process, whether the program and/or activity that you are requesting assistance with fits within the guidelines, how much funding is available, etc.) please reach out to Kelly Waters at 804-740-8643 or info@vahemophilia.org.

Applicants Name *

First

Last

Date of Birth *

Name of Parent or Guardian if under 18:

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Email *

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?

Have you ever received funding from VHF? *

Yes
No

If yes, what was the funding for and how much was it for?

Program and/or Activity you are applying for? *

Dates of Program and/or Activity? *

Cost of Program and/or Activity? *

Application and/or Payment Deadline for Program and/or Activity? *

Informational and/or Supporting Documents for Program/Activity

Click or drag a file to this area to upload.

Would you be willing/able to participate in program and/or activity if a partial scholarship is offered/available?

Yes
No

If no, please explain: *

ESSAY: Explain what you hope to gain by participating in this program: *If you prefer to upload a separate document with this information write n/a in the text box and use the File Upload below* *

Essay File Upload

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Describe your previous participation with the chapter and how you plan to contribute to VHF and support other persons with inherited bleeding disorders. *If you prefer to upload a separate document with this information write n/a in the text box and use the File Upload below* *

Chapter Participation File Upload

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Any other pertinent information you would like to share with the chapter? *If you prefer to upload a separate document with this information write n/a in the text box and use the File Upload below* *

Additional Information File Upload

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SCHOLARSHIP GUIDELINES

Scholarship recipients will be determined through a review process conducted by volunteers on the VHF Scholarship Committee • Scholarships are limited to funding availability • Priority/special consideration is given to: First time applicants and those individuals not previously funded by VHF, Individuals diagnosed with an inherited bleeding disorder, Individuals who have volunteered and/or are an active participant of VHF, Those individuals who are clearly able to communicate a need and would benefit from participating in such a program, Applicant’s intention to make effective use of the program (write an article for the newsletter or speak about the experience at an upcoming VHF event). *

Yes, I understand.

Scholarships will be for costs associated with registration/enrollment. You will be responsible for all other fees. Payment will be made directly to the entity OR a receipt must be provided for reimbursement. Documentation of attendance is required. *

Yes, I understand.

Applicants must live within VHF’s territorial jurisdiction; which include the Commonwealth of Virginia, with exception of the following: The cities of Alexandria, Fairfax, Falls Church, Herndon, Manassas, Manassas Park, and Vienna and the counties of Arlington, Fairfax, Fauquier, Loudon, Prince William and Stafford *

Yes, I certify that I live within the VHF territorial jurisdiction.

Scholarship recipients understand that if they are selected, expenses are paid, and then they do not participate in the program or fail to give a valid excuse they may be asked to reimburse VHF for all expenses incurred on their behalf. *

Yes, I understand.

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.

If you have questions about this scholarship (application process, whether the program and/or activity that you are requesting assistance with fits within the guidelines, how much funding is available, etc.) please reach out to Kelly Waters at 804-740-8643 or info@vahemophilia.org.

SCHOLARSHIP GUIDELINES

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