SHE Roots Scholarship Application

SHE Roots Scholarship Application

S.H.E. Roots - Scholarship Honoring Excellence: Rooted and Grounded in Growth and Purpose. The SHE Roots Scholarship is designed to uplift and support women and female-identifying individuals who are pursuing higher education, vocational training, or community projects. By proceeding with this application, you confirm that you meet this eligibility requirement.
Name*

First NameLast Name
Date of Birth*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
One-Minute Introduction Video (Introduce yourself, your goals, and how this scholarship will support your growth and impact. (File Upload-- accept MP4, MOV, WMV; size limit around 100MB)*

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Photo Submission (If selected as a SHE Roots Scholarship recipient, we may request to feature your photo for announcements, marketing, and recognition purposes. (Please upload a recent photo/headshot of yourself) File Upload --accept JPG, PNG; 5-10MB size limit)*

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Pathway Selection
Are you applying as a:*

Student (College, University, Trade, or Vocational Program)Community/Personal Project Applicant

Student
Current School/Program Name*
Expected Graduation Date*

MonthDayYear
Date
Upload Transcript (File Upload- PDF/JPG/PNG, required)*

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Upload Proof of Enrollment or Acceptance Letter (File Upload- PDF/JPG/PNG, required)*

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Community & Service: In what ways have you given back to your community, and why is service important to you?*
Mental Health & Well-Being: What practices or supports help you take care of your mental health and stay balanced as a student?*
Challenges & Triumphs: Share one challenge you've faced in your personal, academic, or community journey--and how you turned it into a moment of growth or triumph.*
Identity & Purpose: How has your identity or lived experience shaped the way you see your education and future goals?*
Legacy & Community Impact: What lasting impact do you hope to leave in your school, community, or future profession?*
Resilience in Education: What has been one of your biggest personal or academic obstacles, and how has it shaped your determination to continue?*
Mental Health Awareness: Why do you believe mental health and wellness are important for students, and how do you support your own well-being?*
Leadership & Growth: Describe a time when you stepped into a leadership role or helped guide others. What did you learn from the experience?*
Mission & Values Alignment: Which of the SHE Roots Values--Grounded, Growth, Purpose, or Uplifting Community--speaks to you the most, and how do you live that out in your everday life?*

Community / Personal Project Applicant
Community/Personal Project Applicants (Branch B)(If you are applying as a Community/Personal Project applicant, please complete the following. Your responses should outline the purpose, activities, and intended impact of your project).*
Project Summary: Please describe your project in 250-500 words, include:-What inspired this project?-The community or group it serves?-Why it matters?*
Project Goals: List 2-3 main goals your project aims to achieve.*
Activities & Plan: Describe the activities you will carry out, including a timeline.*
Measurable Outcomes: How will you measure success? (Ex: # of participants, feedback, awareness raised, resources created)*
Budget Overview: A brief outline of funding needs (supplies, space, materials, etc):*
Community Impact: Explain how your project will uplift women, girls, and broader community.*
Upload Project Plan: 1-page max*

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Mission & Values Alignment: Which of the SHE Roots Values--Grounded, Growth, Purpose, or Uplifting Community--speaks to you the most, and how do you live that out in your everday life?*
How does your project or community work support mental health, wellness, or resilience--either for yourself, your community, or the people you hope to impact?*

Personal Statement/Essay (500-750)
Essay (500-750 words)Prompt: If you could go back and speak to your younger self during a challenging season, what would you say? Share how that message reflects the lessons you've learned, the growth you've experienced, and the resilience you carry today. In your response, also describe how these experiences have prepared you for your future goals and the impact you hope to make in your community. *
Influences & Role Models: Who has been the most influential person in your life, and what lesson from them do you carry with you today?*
Barriers & Equity: What barriers or inequalities have you faced in pursuing your goals, and how have you worked to overcome them?*
Cultural Identity: How has your cultural background or heritage shaped your identity, resilience, or the way you see your future?*
Advocacy & Voice: If you had a platform to raise awareness on one issue impacting women or your community, what would it be and why?*
Gratitude & Grounding: What is one thing you are most grateful for right now, and how has it shaped your perspective?*

Recommendation
Upload 1-2 Letters of Recommendation (From a teacher, mentor, faith leader, supervisor, or community leader who can speak to your character and commitment to service).*

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Resume /Activity Sheet
Proof of Community Serivce (5+ verified hours in last 12 months): Upload documenation (signed letter from an organization, supervisor, or event coordinator)*

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Upload Resume or Activity Sheet(Include community service, leadership roles, extracurricular activities, or work experience)*

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Financial Need Statement
Describe your financial need (300 words max)*

Signature & Agreement
Media & Release Agreement: By submitting this application, I acknowledge and agree that if I am selected as a recipient of the SHE Roots Scholarship, any photos or videos I submit in connection with the scholarship (including but not limited to headshots, introduction videos, and recipient reflection videos) become the property of Twelve Royal Gems Women's Mental Health PLLC. I grant Twelve Royal Gems Women's Mental Health full rights to use these materials for purposes including, but not limited to: - Scholarship announcements and award recognition.-Marketing, promotional, and fundraising materials.-Social media, website, and digital publications.-Print or media coverage related to the SHE Roots Scholarship understand that these materials may be used without further notification, compensation, or prior approval, and I release Twelve Royal Gems and its representatives from any claims arising from such use. Consent Agreement (Required for Submission)*

I have read and agree to the Media & Testimonial Release Disclaimer.
Recipient Commitment (Required for Consideration) If selected as a SHE Roots Scholarship recipient, you will receive a certificate of award. By submitting this application, you agree to the following requirements upon selection: 1. Submit a 1-minute reflection video sharing your experience, how the scholarship impacted you, and your future goals.2. Allow SHE Roots to use this video for scholarship recongnition, testimonials, and promotional purposes. Do you agree to this recipient commitment?*

YesNo, I do not agree (not eligible for consideration)
Acknowledgement: 1) I confirm that I meet all eligibility requirements. 2) I understand that scholarship awards are considered gifts and may be subject to recipient tax obligations.*

I agree
Confirmation*

I certify that the information provided is accurate to the best of my knowledge. I understand that submission does not guarantee selection. By submitting, I consent to the review of my application by the SHE Roots Scholarship Committee.
Scholarship Awareness Question: How did you hear about the SHE Roots Scholarship?-Social Media (Instagram, Facebook, etc.)-School/University-Community Organization-Friend/family referral-other (please specify)*
Consent for Future Opportunities: Would you like to be contacted about future opportunities, programs, or events hosted by Twelve Royal Gems?*

YesNo
If yes, sign up for updates:

Since you selected Yes, you can join our official mailing list to receive updates about future scholarships, programs, and opportunities with Twelve Royal Gems. Click here to subscribe: https://www.twelveroyalgems.com (scroll down to subscribe)
Signature (Thank you for applying for the SHE Roots Scholarship: A Scholarship for Grounded Growth & Purpose. You willl receive an email confirmation once your application is received. Selected finalists will be contacted directly).*

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Questions or Assistance:

If you have any questions about this application, or encounter technical difficulties, please contact us at:
Email: Scholarship@TwelveRoyalGems.com
Website: www.TwelveRoyalGems.com
Thank you!

Thank you for taking the time to apply for the SHE Roots Scholarship: A Scholarship for Grounded Growth & Purpose. Your voice, your journey, and your commitment to growth matter deeply. Regardless of the outcome, continue planting seeds of impact and possibilities in your community and within yourself.

With gratitude, Twelve Royal Gems Women's Mental Health PLLC
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