2026 Reference Form for IASCNAPA Scholarship Applicants

Date*

Date

Name of Applicant for IASCNAPA Scholarship*

First NameLast Name

The above-named student is applying for a scholarship from the International Association of Sickle Cell Nurses and Professional Associates, Inc. (IASCNAPA). These scholarships are available to individuals living with sickle cell disease, with applications accepted from March through July 1 each year. All reference forms must be submitted by July 1. The Scholarship Committee carefully reviews each application and selects recipients based on academic achievement and potential, as well as personal motivation, character, writing ability, and involvement in school and community activities.

Your evaluation is an essential part of this process, and we sincerely appreciate your time and thoughtful recommendation. If you have any questions, please contact Jane Zepeda at jane.zepeda@daac-prc.com or iascnapainfo@gmail.com.

We also extend our sincere gratitude to the supporters of IASCNAPA scholarships: the Steven Christy Scholarship Fund and the Dr. Christine Johnson Scholarship Fund.

Your Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Your email*

Confirmation Emailexample@example.com

Are you an active IASCNAPA member or a medical professional*

Can you confirm that the applicant has sickle cell disease

Title (if NA, please put NA)*

How long have you known the applicant?*

In what capacity have you known the applicant?*

Please briefly describe the applicant’s key strengths and/or any areas for growth that the committee should consider when reviewing the application (50 words or fewer).*

0/50

Please share any additional information that would help the committee evaluate the applicant’s qualifications, character, and potential (100 words or fewer). *

0/100

Recommendation*

eSignature (by typing your name below you agree that the information you provided is truthful and accurate). *