IASCNAPA SCHOLARSHIP APPLICATION

IASCNAPA SCHOLARSHIP APPLICATION

Thank you for your interest in the International Association of Sickle Cell Nurses and Professional Associates, Inc (IASCNAPA) scholarship. IASCNAPA has established a competitive college scholarship program to assist students with Sickle Cell Disease who will be attending an institution of higher learning in the United States. A sincere thanks to the funders of two IASCNAPA scholarships: the Steven Christy Scholarship Fund and the Dr. Christine Johnson Scholarship Fund. Applicants for IASCNAPA's $1,500 Scholarships must have a form of sickle cell disease and be enrolled in or have been accepted by a recognized and accredited post- secondary school; including college, university, trade school, or other institution of higher learning. Curriculum choice, age, gender, race, ethnic background, religion and political affiliation will not be used in evaluating applications. An active IASCNAPA member or a sickle cell disease medical provider must sponsor all applicants. Applications are accepted from March 1 through July 1 of each year. Members of the scholarship committee will carefully review each complete application and determine the recipients of the scholarships in August of each year. Each applicant will receive a letter of notification by email at the email address listed on the application form. Scholarship awards will be sent directly to the student by September. For questions please email: V. Jane Zepeda, MPAS, PA-C Advanced Practice Provider Sickle Cell Program Pediatric Hematology vilailuk.zepeda@utsouthwestern.edu or admin@iascnapa.org for any questions.
Do you have sickle cell disease? If yes, your IASCNAPA member or medical reference must state in their letter of reference that you have sickle cell disease. *
If no, please do not proceed, you are not eligible and your application will not be reviewed.
Are you currently attending college or post-secondary school; i.e., trade school after high school. *
If no, please do not proceed, you are not eligible and your application will not be reviewed.
Have you received the IASCNAPA scholarship four times? *
If yes, do not proceed - four times is the maximum number of times you can receive the scholarship.
Before you begin your application, make sure you have the following documents.
Today's Date *

Month Day Year
Date
Name *

First Name Last Name
Your Email *

Confirmation Email example@example.com
Home Address *

Street Address

Street Address Line 2

City State

Zip Code
Cell Phone Number *
Please enter a valid phone number.
Name of sponsor (Active IASCNAPA Member or Medical Provider) *

First Name Last Name
Email of sponsor (Active IASCNAPA Member or Medical Provider) *

Confirmation Email example@example.com
Name of School Attending in 2022-2023 School Year (you will be required to Upload your letter of acceptance) *
Address of School *

Street Address

Street Address Line 2

City State

Zip Code
Date of Acceptance *

Month Day Year
Date
Major in School *
Please state your career objectives in 100 words or less *

0/100
Please list the name of high school or college most recently attended *
Please list the date (school year) of last attendance at high school or college. for example school year 2021-2022. *

Month Day Year
Date
Name of Reference #1 *

First Name Last Name
Phone number of Reference #1 *
Please enter a valid phone number.
Email of Reference #1 (One reference must be an IASCNAPA active member or a medical professional that can verify your sickle cell status). *

Confirmation Email example@example.com
Name of Reference #2 (One reference must be an IASCNAPA active member or a medical professional that can verify your sickle cell status). *

First Name Last Name
Phone number of Reference #2 *
Please enter a valid phone number.
Email of Reference #2 *

Confirmation Email example@example.com
List activities, leadership positions and significant responsibilities in school, community, home and church: Limit 300 characters *
List honors (scholastic, citizenship, artistic, etc.), awards, and other forms of recognition that you have received: Limit 300 characters *
List hobbies and special interests: Limit 300 characters *
Have you been employed during the school year? *
What type of job during the school year?
How many hours per week during the school year?
Have you been employed during the summer? *
How many hours during the summer?
What type of job during the summer?
PERSONAL STATEMENT This portion of the application is intended to assist the scholarship committee in obtaining a better sense of you as a person and as a student. You are free to use whatever approach you find most appropriate to tell us more about yourself and your goals. The scholarship committee hopes that you will touch upon some or all of the following areas in your statement. PLEASE LIMIT YOUR STATEMENT TO 250 WORDS OR LESS 1) Factors such as family, culture, education, etc. that have most influenced your development as a person committed to pursuing your educational goals; 2) What impact sickle cell disease has had upon your life and your choice of career; 3) Your perception of yourself as a member of the profession or career field you have chosen. *

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Upload Letter of Acceptance from School (or other proof of admission for upcoming semester) *

Cancel of
Upload Picture *

Cancel of
Before submitting make sure you have: *
By esigning below, you are agreeing to allow the information submitted to be reviewed by the IASCNAPA scholarship committee and board members. Additionally, if awarded an IASCNAPA scholarship, you agree to provide a W9 for tax purposes and to allow IASCNAPA to post your scholarship award, picture, school, and brief academic statement on IASCNAPA website and for use in advertising material. *
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