A Reflection of Me, Inc Scholarship Application Form

Scholarship Application Form

Application Deadline - April 10, 2026
Read and follow the instructions carefully prior to submitting your application. (link to instructions here). All winners will be notified by the 15th of May 2026 at school awards recognition event or at A Reflection of Me, Inc event.
Read and Understand the instructions.*

Yes, I have
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.

If selected, you also agree to be featured via picture, video, and vocals throughout our various platforms.
I. Personal Data:

Tell us about yourself
Full Name*

First NameLast Name
Birthdate:*

MonthDayYear
Mobile No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Guardian Name

First NameLast Name
Guardian Mobile No. :

Area CodePhone Number
Home Address :*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Additional Information:

Information regarding gender, ethnic origin, race and disability are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for scholarship awards. However, providing this information may increase your opportunities for scholarships where donors have asked that priority consideration be given to students meeting certain demographic criteria (such as minority status, parent's place of employment, area of study, etc.)
Gender:*

MaleFemaleN/AOther
Are you a US citizen?*

YesNoPrefer not to respond
Are you a Permanent Resident?*

YesNoPrefer not to respond
Ethnic Origin:*

HispanicNon-HispanicNot IndicatedPrefer not to respond
Race? (Choose one or more):*

WhiteBlack or African AmericanAsianNative American or Alaskan Native Hawaiian or Other Pacific IslanderPrefer not to respondOther
Status at the time of application:*

I am a senior in high schoolI will be an incoming freshman in collegeI am currently in collegeI am currently attending a vocational/trade school
Are you a first generation college/vocational school student ?*

Yes, I am the first among my parents or grandparents to attend college.No, either my parents or grandparents have attended college.N/A (If going to trade School)Other
Are you a first generation Vocational School student ?*

Yes, I am the first among my parents or grandparents to attend vocational school.No, either my parents or grandparents have attended vocational school.N/A (If going to college/university)
Major Area of Study:*
Please indicate what is your major are of study
What is your Career Objective:*

0/300
Which scholarship are you applying for?
Scholarships:*

Let's Build It Scholarship {arts)Maitild Joisil & Leonne Mathias Community Engagement Scholarship (community service)
II. High School Information:
High School Attending/ed:*
Year of High School Graduation or GED:*
Most recent cumulative GPA:*
High School activities, community activities, volunteer work, honors, offices held:*
Provide 2 individual references (may not be a relative), preferably teachers community service site coordinator/manager. Provide their names, email address and phone numbers.*
Attach 2 individual reference letters (may not be a relative), preferably teachers, community service site coordinator/manager.
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V. College/University or Vocational/Trade School :

If applicable
Name:
Current GPA:
School activities, honors, offices held, etc.:
VI. Extras:
Have you previously received a scholarship with A Reflection of Me, Inc?*

YesNo
Do you have a disability?*

YesNo
Are you a GED recipient?*

YesNo
Do you reside in South Florida?*

YesNo
In addition to a scholarship, would you like to be considered for an internship opportunity/volunteer with A Reflection of Me, inc?*

YesNo
VII. Essay
Your essay should be 500-1500 words. You should briefly address in your essay: your college/vocational goals and choice of major, what you intend to do with your education as you previously disccused above. Here, mainly share more about yourself, your values, and why a scholarship is important to you. Include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.

If you are applying for the Community Engagement scholarship, please emphasize of your community service activities.
Essay:*

0/1500
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
A Reflection of Me, Inc is an IRS recognized 501c3 nonprofit, dedicated to promoting culture and community connection through the arts. We are committed to equal opportunity in employment and education. The organization does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
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Scholarship Application Form

I. Personal Data:

II. High School Information:

V. College/University or Vocational/Trade School :

VI. Extras:

VII. Essay

VIII. Applicant's E-Signature