Adobe FormsCentral

Academic Information
Current Academic Affiliation
Name of School *
City *
State *
Zip Code *
Country *
Major *
Expected Degree *
Date I began studies: *
Expected Date of Graduation *
Academic History - list other schools and universities attended (most recent first)
Name of School (#1)
Dates Attended
Degree Received
Major
Name of School (#2)
Dates Attended
Degree Received
Major
Name of School (#3)
Dates Attended
Degree Received
Major
Name of School (#4)
Dates Attended
Degree Received
Major
Academic honors, distinctions, and achievements:
Extracurricular, volunteer, leadership, and professional activities:

What are Your Plans for Academic Year 2016/2017
List the year and level of studies you will be engaged in during academic year September 2016 - June 2017.

Examples: freshman year of undergraduate studies, second year of graduate level studies, third year doctoral studies.
Year and Level of Studies in 2016/2017:
Candidates in combined programs. Provide details for 2016/2017.
Candidates entering first year of studies (any level) and transfer students, provide details concerning where you expect to study during academic year 2016/2017:
Name of School
City
State
Country
Major
Expected Degree
Expected Date of Graduation
As of this date, have you been accepted by the above named school?

Yes No
Are you applying for a teaching assistantship for academic year 2016/2017?

Yes No

Family Background
Father's First Name *
Father's Last Name *
Father's Date of Birth *
Father's Place of Birth *
Father's Ethnic Background *
Father's Occupation *
Father's Address *
City *
State *
Zip Code *
Country *
Father's Phone *
Father's E-mail
Mother's First Name *
Mother's Last Name *
Maiden Name *
Mother's Date of Birth *
Mother's Place of Birth *
Mother's Ethnic Background *
Mother's Occupation *
Mother's Address *
City *
State *
Zip Code *
Country *
Mother's Phone *
Mother's E-mail

Scholarships I Have Received from the Kosciuszko Foundation
Type of Scholarship
If Other, please specify:
Scholarship Amount
for academic year
Did you accept the scholarship?

Yes No
Type of Scholarship
If Other, please specify:
Scholarship Amount
for academic year
Did you accept the scholarship?

Yes No
Type of Scholarship
If other, please specify:
Scholarship Amount
for academic year
Did you accept the scholarship?

Yes No
Supporting Documents
(Acceptable formats: .doc, .docx, .pdf, .png, .jpg, .jpeg)
Attach a passport-style photo of yourself, suitable for publication. Save the file as, "TU17-Last name-first name-photo" and upload below.
Photo: *
Attach a Statement of Purpose. Discuss your major, specialization and academic goals. Your statement should be two-three pages, double spaced. Include your full name, TU 2016/2017 and page number in the upper right hand corner of each page of your statement. Save your file as, "TU17-Last name-First name-essay" and upload below.
Statement of Purpose: *
Complete and attach the Financial Information Form found at the bottom of the KF Scholarship description page: http://www.thekf.org/scholarships/tuition/Financial_Information_Form.docx Save your completed form as "TU17-Last name-First name-FIF" and upload below.
Financial Information Form: *
Attach your Resume or Curriculum Vitae (optional). Save your file as, "TU17-Last name-First name-CV" and upload below.
Curriculum Vitae :
Attach your Letter of Admission/Acceptance. This supporting document is required for students who are beginning undergraduate, graduate and doctoral studies. Save your file as "TU17-Last name-First name-Admission" and upload below.

If you have not received an acceptance letter before the scholarship application deadline, you may submit your letter via e-mail to Addy@thekf.org through May 30, 2016.
Admission/Acceptance Letter:

Proof of Polish Ancestry
While a small number of Kosciuszko Foundation's Tuition Scholarships are awarded to promote the study of Polish language, history, and culture by Americans, the majority are awarded to candidates of Polish ancestry. In order to qualify for the majority of awards, candidates must show proof of Polish heritage. It is recommended that candidates of Polish ancestry choose the ancestral line which is easiest to document.
Attach Proof of Polish Ancestry. To prove Polish descent, submit birth certificates, passports, naturalization papers, marriage certificates, ship manifests, and other offical documents which show that you are related to an individual who was born in Poland. For example, if your maternal grandmother was born in Poland, you would submit a copy of your birth certificate and your mother's birth certificate. Birth certificates usually include the name, date and place of birth of an individual as well as information about his/her parents including their names and places of birth. These two documents show the ancestral lineage of three generations. They show your connection (1st generation) to your mother (2nd generation) and to your grandmother (3rd generation). Scan copies of official documents to one file. Save the file as, "TU17-Last name-First name-ancestry" and upload it at the button below.
Proof of Polish ancestry
Letters of Reference
Request letters of recommendation from two professors you have studied with. Letters should be submitted on school or university letterhead. Recommenders may send letters via e-mail directly to Addy@thekf.org or via mail to: Grants Department, The Kosciuszko Foundation, 15 E 65th Street, New York, NY 10065. Please provide the names of your recommenders below.
Name of professor *
Title *
Institution *
E-mail *
Name of professor *
Title *
Institution *
E-mail *
You may submit an additional letter of recommendation (optional). Please provide:
Name of professor
Title
Institution
E-mail

Agreements and Supporting Materials
Consent Agreement
By checking the box below, I certify that the information supplied on this application is true and correct to the best of my knowledge. I authorize the KF Scholarship Committee and administrative staff to process, review and discuss my application materials.
The information I have supplied in this application is true. *

true
Supporting Materials
By checking the box below, I confirm that I have ordered official transcripts (3 years through Summer 2015) to be sent to the KF. Official transcripts must be mailed by your school directly to : Grants Department, The Kosciuszko Foundation, 15 East 65th Street, New York, NY 10065.
I have ordered transcripts of study to be mailed to the KF. *

true
By checking the box below, I confirm that I have requested letters of academic reference from the persons named on page 6 of this application. Letters of recommendation may be sent directly to Addy@thekf.org or sealed and mailed to : Grants Department, The Kosciuszko Foundation, 15 East 65th Street, New York, NY 10065.
I have requested letters of recommendation from two of my professors. *

true
Application Fee
By checking the box below, I acknowledge that have submitted a non-refundable application fee of $35 made payable to the Kosciuszko Foundation and mailed to : Grants Department, Kosciuszko Foundation, 15 East 65th Street, New York, NY 10065.
I have mailed my application fee to the KF. *

true
Changes in Contact Information and/or Study Plans
Scholarships are awarded based on the information you present in your application. By checking off the box below, I acknowledge that I will notify the Kosciuszko Foundation of changes in my major, school/ university, changes in residence and other substantive changes.
I agree to notify the KF of changes in study plans and contact information. *

true
Should be Empty:

AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY