Seize Your Future Foundation Application
Deadline for submission: 02/01/2026 Award Amount: $1,000
Name
First Name
Last Name
Email
*
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have an epilepsy diagnosis?
*
Yes
No
Highest level of education completed
*
Please Select
Currently in high school
High School Diploma/GED
Some college
Bachelors
Trade school
other
What institution/trade school are you currently enrolled in for the upcoming semester?
*
Program of study
*
Expected graduation date
-
Month
-
Day
Year
Date
What are your educational career goals?
*
Additional comments
500-700 word essay submission OR document with video submission URL
*
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Letter of recommendation (from medical or educational professional required)
*
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Proof of enrollment, transcript/academic record, or letter of good academic standing from registrar
*
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PLEASE READ BEFORE YOU SUBMIT: I, grant Seize Your Future my permission to use the photographs, logo and name(s) I have provided for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
*
Yes
No
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