Friends of DBA Scholarship Application Form

FRIENDS OF DBA

14666 Regency Drive
Strongsville OH 44149

CMancuso@friendsofdba.org

www.friendsofdba.org

440-213-1671
Scholarship Application Form

Application Deadline - Nov 30, 2025
Read and follow the instructions carefully prior to submitting your application. All recipients will be notified on or before January 15, 2026.
Our goal is to continue supporting our mission statement and award candidates that fall into it.

Our mission statement: As a Foundation, Our mission is to generate funds for research to find a cure for Diamond Blackfan Anemia (DBA). Our additional purpose is to provide DBA Families with education when necessary and to assist DBA Families in crisis.

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.
I. Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Mobile No*
Format: (000) 000-0000.
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Optional Informations

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards.
MaleFemaleOther
YesNo
VeteranChild of a VeteranGrandchild of a VeteranSpouse of a VeteranNone of the Above
I graduate in 2025I will be an freshman fall of 2025I have attended college but have less than 32 college credit hoursI have attended college but have at least 32 or more college credit hoursI am a GED graduate with no college credit hours
Major Area of Study
Please indicate what is your major are of study
What is your career objective?

0/300
YesNo
If "yes" what type of schooling?
II. High School Information
YesNo
High School Attended
Year of High School Graduation or GED
Most recent cumulative GPA
High School activities, community activities, volunteer work, honors, offices held
III. For Students Currently Enrolled in school
Name of school attending
Approximate credit hours completed by May 2025
Current GPA
School activities, honors, offices held, etc.
IV. Extras
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
If so, which country?
YesNo
If so, which country?
YesNo
Full-timePart-time
VII. Essay
Your essay should be 300-500 words. You should address in your essay: your college goals and choice of major, what you intend to do with your education, 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.
Essay

0/500
Do you or your family members have DBA (Diamond Blackfan Anemia)? Please let us know how you are connected to DBA and, if so, how this has affected you.
VIII. Applicant's E-Signature
By signing 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.
Signature

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Friends of DBA committed to equal opportunity in employment and education. Friends of DBA 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

III. For Students Currently Enrolled in school

IV. Extras

VII. Essay

VIII. Applicant's E-Signature