T1D Mod Squad Scholarship Application

Academic Scholarship Application -2025

The information provided on this form will be used by T1D Mod Squad to select recipients for scholarships. Questions? Please email: scholarships@t1dmodsquad.org
Eligibility Requirements
Student's Full / Legal Name*

First NameLast Name
Student's Contact Information*

Phone NumberEmail
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student's High School
Intended college/university:
Student ID to accepted school:
Parent's Name (how it appears in our T1DMD FB page)*

First NameLast Name
Parent's Contact Information*

Phone NumberEmail

SCHOOL / COMMUNITY ACTIVITIES / WORK / EXPERIENCE/SPORTS/AWARDS/ETC:
What activities have you been a part of throughout your high school? What did they mean to you?

In a short essay, please reflect on your experience with T1D. Explain what living with an autoimmune disease is like for you, and what it has taught you.
(350-500 words)

What are your hopes for the future? How do you plan on using your college degree?
(150 word minimum)

Academic Scholarship Application -2025