Please list the name and address of the high school, college, apprenticeship or vocational program that you most recently attended: blanks .

Street Address      City   State   Zip   blank

Dates of Attendance:   Date   
   
Please include a recent picture with your application:

You will be required to include 2 personal recommendations with this application form. It is suggested that your recommendation form be given to a principal, teacher, counselor, employer or someone in the community who knows you well:

1).
Name:   First Name   Last Name   
Address:   Street Address      City   State   Zip   
Telephone Number:      Phone Number  
Email Address:   Email    

2).
Name:   First Name   Last Name   
Address:   Street Address      City   State   Zip   
Telephone Number:      Phone Number   
Email Address:   Email   

Applicant's Name: field.   First Name   Last Name   

Please list your school/apprenticeship/vocational program related expenses for the upcoming year:

1) Tuition and Fees: $   Type Here   
2) Books and Supplies: $   Type Here   
3) Room and Board: $   Type Here   
4) Commuting Expenses: $   Type Here   
5) Other (please specify):   Type here    

Total: $  Type Here   

List activities,leadership positions and significant responsibilities in school, community, home and church: 

  Type Here   


List Honors (scholarships, citizenship, artistic, etc), awards and other forms of recognition that you have received:  

 Type here   

List Hobbies and special interests:   Type here   

Have you ever been employed during the school/apprenticeship/vocational program year:    Please Select Yes No                
If Yes, How many Hours per week:Type here   
Position/Role:   Type Here   

Have you worked during the summers: Please Select Yes No    
Full or Part time:       Please Select Type Option 1 Type Option 2 Type Option 3      
Position/Role:   Type here   

This portion of the application is intended to assist the scholarship committee in obtaining a better sense of you as a person and as a student. How has living with sickle cell disease shaped your personal growth, academic journey, and future goals? Please share specific experiences that have influenced your perspective on resilience, community, and overcoming challenges. PLEASE LIMIT YOUR STATEMENT TO 250 WORDS OR LESS AND PRINT OR TYPE ON THIS PAGE OR ATTACH A SEPARATE DOCUMENT:


 Type Here   

By signing the application you grant THE GLADYS STREET FOUNDATION, INCORPORATED consent to use your photograph and academic summary for the purpose of scholarship publicity, web advertising and content:

Signature   

Applicant's Name:   First Name   Last Name   
Applicant's Signature:   Signature   
Date:   Date   


TO WHOM IT MAY CONCERN:
I am applying for a scholarship from THE GLADYS STREET FOUNDATION, INC. I request that the following information be released to the address below (e-copy or hard copy).


1. A copy of my complete academic record:
a). A transcript of work completed, and
b). A listing of courses in which I am currently enrolled, if applicable:

2.Grade Point Average:   Type here   
Class Rank:   Type here   out of   Type here   students.

3.A copy of my Scholastic Aptitude Test Scores and/or other pertinent test scores

If not submitting any test scores, check here:    Please Select Yes No    




Must be returned by March 31st at 3pm CST of the application year. Awards will be given in August of that year. Send additional application materials to:

THE GLADYS STREET FOUNDATION, INCORPORATED
Attention: Scholarship Committee
333 W. Brown Deer Rd. Suite G #4200,
Bayside WI 53217

thegladysstreetfoundation@gmail.com