Educational Scholarship Application NOHF/COCNHF

Application for Educational Scholarship
Who is eligible to apply?

Any members with a diagnosed, factor deficient bleeding disorder living or being treated in our service area are eligible to apply for a scholarship up to $500 per calendar year to be used towards tuition, books, and tutoring. For Tuition, the candidate must be currently enrolled in an accreted post-secondary school or vocational/ technical center and have a 2.5 GPA or higher. When funds are available, caregivers may also apply.Checks will be written out directly to the educational institution. We will not reimburse for expenses paid.
Checks will be written out directly to the educational institution.
We will not reimburse for expenses paid.
Checklist for submission
Date*

MonthDayYear
Date
First Name*
Last Name*
Age*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Email Address*
Name of School*
Address of School*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current GPA (Please attach transcript)*

Cancelof
Current bill from educational institution (Please attach)*

Cancelof
Type of Bleeding Disorder*
Which Hemophilia Treatment Center are you seen at?
I give my HTC or treating hospital permission to confirm my/my family members' bleeding disorder diagnosis with chapter staff. This information will be held confidential and will not be shared.

Yes (Required to attend programs and receive services)No
Signature of Applicant

Clear
Please verify that you are human*

Application for Educational Scholarship

Who is eligible to apply?