General Scholarship Application

Scholarship Application 2026

Helping people with epilepsy achieve their academic goals.
Personal Information

This application is for people with epilepsy who will be attending a higher education facility within the United State such as a university or trade school.
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Type
Alternative Phone Number
Format: (000) 000-0000.
Type
E-mail
Home address

Street

Apt/Unit #

CityState

Zip Code
In 300-500 words, explain how epilepsy has influenced your daily life, academic performance, and social interactions. How do you plan to help others living with or caring for someone with epilepsy?

0/500
Academic Record
Current Education Level
List any honors, awards, extracurricular, or volunteer activities that demonstrate your academic excellence and commitment.
Describe your aspirations for higher education and how the scholarship will help you achieve them.
Educational Institution (Fall 2026)
*We understand that a final decision on the institution may not be known at this time. You should still apply for this scholarship and will be given full consideration in the process. If selected, we willl need an acceptance letter from your US institution before releasing funds.
Reference letters

Please include a personal, an educational or professional letter of reference, along with a reference letter from your neurologist or epileptologist.
Personal, Educational or Professional

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Scholarship Application 2026