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COLLEGE SCHOLARSHIP PROGRAM

FACES (Finding a Cure for Epilepsy and Seizures) is pleased to accept applications for the 2021 College Scholarship Program. FACES will provide financial support for the education of college undergraduate or graduate students affected by epilepsy and seizure disorders. We are seeking to recognize the personal accomplishments of those living with epilepsy during their higher education journey.

AWARD AMOUNTS WILL VARY AND WILL NOT EXCEED $2,500 PER STUDENT, DEPENDING ON THE APPLICANT’S FINANCIAL NEED.

PAST RECIPIENTS ARE WELCOME TO APPLY AGAIN

TO APPLY, PLEASE SUBMIT THIS APPLICATION AND ALL SUPPORTING DOCUMENTS BY:

FRIDAY, JUNE 25, 2021

APPLICATIONS WILL NOT BE ACCEPTED AFTER THIS DATE
YOU WILL BE NOTIFIED OF A DECISION ON FRIDAY, JULY 30, 2021

ALL GRANT AWARDEES WILL NEED TO PROVIDE A W-9.

Eligibility requirements:

Is a US Citizen and/or a legal and permanent resident of the United States
Lives with and encounters challenges from epilepsy or a seizure disorder
Has financial need
Must attend a United States higher education institution
Will be enrolled as a college student in the Fall 2021

SECTION I.

A.
APPLICANT INFORMATION

Student Information (Please Print or Type)

Title: *

First Name: *

Last Name: *

Middle Initial: *

Permanent Home Address: *

City: *

State: *

Zip Code: *

Home telephone: *

Mobile: *

Email: *

Age for academic 2021/22 school year: *

Date of birth: *

Sex of Applicant : *

Are you a U.S. citizen or permanent resident?: *

FINANCIAL INFORMATION

Did you file for income taxes?: *

If so how many dependents did you claim?: *

Did your parents claim you as a dependent: *

Total number of dependents under the age of 18 your parent(s)/legal guardian(s) have living at home?: *

Household income: $: *

Tuition for other children? : *

Estimated amount $: *

Out of pocket yearly medical expenses?: *

Estimated amount $: *

Are / will you be receiving financial assistance while attending college?: *

Are you receiving financial aid or support for the upcoming academic year ?: *

Have you applied for this scholarship before?: *

Who is your doctor at the NYU CEC? Put none if not a patient here. This will not impact your award:

For the following forms of financial aid, please list the name of the loan or grant and the estimated/anticipated amount of funds you will be receiving/taking out:

Federal loans:

Name: *

Amount $: *

Private loans:

Name: *

Amount $: *

Grants:

Name: *

Amount $: *

Scholarships:

Name: *

Amount $: *

Work study:

Name: *

Amount $: *

If you answered yes to any of the above, supporting documentation may be requested.

ACADEMIC INSTITUTION INFORMATION (FOR ALL APPLICANTS)

Name of college you are/will be attending: *

Address: *

City: *

State: *

Zip Code: *

Main Phone number: *

Declared major: *

Declared minor: *

Date enrolled: *

Are you living on campus?:

If Yes, room + board amount: if No, put $0:

Estimated tuition amount: *

ACADEMIC INFORMATION

HIGH SCHOOL INFORMATION (REQUIRED FOR INCOMING FRESHMEN ONLY)

Name of high school:

School address:

City:

State:

Zip Code:

Phone number:

Contact person:

Graduation date:

Official transcript GPA:

SECTION II.

OFFICIAL TRANSCRIPT AND RESUME:

TRANSCRIPT

Incoming freshmen, please send your most up-to-date high school official transcript. Current college students, please send your most up-to-date official college transcript. Please submit your high school or current college transcript to:

FacesScholarship@nyulangone.org OR
Attn: Brielle Cummings, NYU FACES, 223 East 34th Street, New York, NY 10016

RESUME

Please enclose a resume of any honors, academic achievements, extracurricular activities, community service, and work experiences.

Resume - REQUIRED:

SECTION III.

LETTERS OF RECOMMENDATION:

A.
ACADEMIC RECOMMENDATION LETTER

Please have someone involved in your academic career (teacher, professor, tutor, guidance counselor, coach) write a letter of recommendation indicating why this scholarship will be helpful for your college education. This letter should speak to your character, work ethic, and how epilepsy has effected you. (1,000 word maximum)

Academic Letter of recommendation :

Academic reference name: *

Relationship to student: *

Contact email: *

Contact phone: *

***Please make your reference aware, we may be contacting them.***

MEDICAL RECOMENDATION LETTER

Please have a certified medical practitioner who is involved in your medical care (e.g. physician, nurse practitioner, physician assistant, nurse, physical therapist, occupational therapist, social worker, psychologist, etc.) write a letter of recommendation indicating why this scholarship will be helpful for your college education. This recommendation must state the applicant has/had an epilepsy diagnosis or experiences seizures. (1,000 word maximum)

Medical letter of recommendation:

Medical reference name: *

Relationship to student: *

Contact email: *

Contact phone: *

***Please make your reference aware, we may be contacting them.***

SECTION IV.

PERSONAL STATEMENT

Please attach a written statement. This statement should highlight:

Why you will benefit from this scholarship.
Any community service. Please highlight any participation in epilepsy awareness programs. If you are unable to volunteer for any reason please explain why.
Explain how you have overcome the challenges of epilepsy.
Your essay should include why scholarship assistance is being requested this year, including financial need.
Any other information you think might be pertinent.
(1,000 word maximum)

Personal statement - REQURED:

Certification

I certify that the information contained in this application is true.

Name of applicant: *

DATE: *

Name of parent or guardian:

DATE: