Brain Cancer Scholarship

Alexia Paige Surdukan & Andrew Wade Heron

Brain Cancer Memorial Scholarships

Applications are due December 31st for the following school year.

This scholaship is made available to childhood brain tumor survivors.
Name

First NameLast Name
Email
example@example.com
Current Mailing Address
City
State
Zip Code
Phone Number
Classification

High School SeniorCollege FreshmanGED RecipientOther
Proposed major field(s) of study:
How has being a cancer survivor developed your character? Please give specific examples. If you had to give advice to someone going through cancer, what would you tell them?
What honors, awards and achievements have you earned? What are your education plans, career goals, and personal goals?
The information given in this application is to be used for consideration for an Addi's Faith Foundation Memorial Scholarship. I pledge that all information provided is correct to the best of my knowledge. I hereby waive my right to inspect and review the confidential evaluations provided by the above designated references or other recommendations which I request to be submitted in support of my application. I also understand and agree that the decision made by the Addi's Faith Foundation on my application will be final.
Signature of Applicant

Clear
Date

MonthDayYear
Date
Scholarships will be mailed directly to institutions, so please ensure that the following information is included correct.
School Name (check payable to):
School Check Mailing Address:
"Partial" Transcript - High School Seniors

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Full Transcript - College Students

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Confirmation of Treatment for Brain Cancer

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Final selections are based on: Application essays, reference forms, academic grade point average, personal interview, and scholarship donor criteria

References: Two "Reference's Confidential Evaluation" forms. Your two references can be anyone not related to you or living in your household. One confidential evaluation should be submitted by teachers, administrators, or counselors connected with the school in which you are currently enrolled or have been enrolled. For students who have not been enrolled in school for a period of more than two years, references should be from an employer, minister, supervisor, etc. Do not submit references from relatives and neighbors. A second reference should be from a doctor or hospital that directed your cancer treatment. If is your sole responsibility to provide these confidential evaluations for your references and then those individuals should mail the completed forms directly to Addi's Faith Foundation.
Refernce #1
Full Name
Phone Number
Email Address
Reference Letter

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Reference #2
Full Name
Phone Number
Email Address
Reference Letter

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Your Photo (This is not required, but we would love to put a face with a name!)

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Should be Empty:

Scholarships will be mailed directly to institutions, so please ensure that the following information is included correct.

Refernce #1

Reference #2