4040 Scholarship Application

APPLY BELOW!
First Name*
Last Name*
Email*
example@example.com
Country (current location)*
Phone Number*
Full Name of Your College or University*
The US State where Your College or University is Located*
Are You Pro-Life?*

YesNo
Please list the pro-life activities that you have been involved in and how you participated. List by most important to least important.*
- You have indicated that you are an EU or EEA resident and are using this form from an EU or EEA location. As of May 25, 2018 the EU has put into effect the General Data Protection Regulation (“GDPR”) which requires that you are clearly informed who is collecting, storing and accessing your personal data (“Controller”); what personal data is being collected; how it is being used; how to access it (“Right of Access”); how to have it removed/deleted/erased (“Right to be Forgotten”; how to get a copy (“Portability); restrict processing; and to object.
  
  For complete information on the EU GDPR, click: https://www.eugdpr.org
  
  WHO IS COLLECTING & USING YOUR PERSONAL DATA?
  All personal data provided by you is controlled, collected, stored, accessed and processed/used by 40 Days for Life, a charitable organization located in Texas, U.S.A.
  
  40 Days for Life only shares your personal data with our trusted partners in furtherance of our Mission to end abortion; and only with your consent.
  
  WEBSITE: https://40daysforlife.com
  ADDRESS: 4112 East 29th Street, Bryan, TX, 77802, U.S.A
  PHONE: +1-888-LIFE-316
  
  Click HERE for our PRIVACY STATEMENT.
  
  WHAT IS PERSONAL DATA?
  Personal data is information that identifies you. 40 Days for Life takes your privacy & security seriously and therefore considers almost all data about you to be personal. Below is a list of the personal data that you will be asked to provide for this application.
  
  WHERE DOES MY INFORMATION GO?
  All information provided by you will be transferred to, stored and accessed in the United States of America solely for the purpose of furthering our Mission to end abortion.
  
  YOUR AGE:
  40 Days for Life does not accept or collect information from minors/juveniles. Please check the box below to indicate whether you are at least eighteen (18) years of age, or the age of majority (if higher) in your location:
- Are you at least 18 years old, or the age of majority in my location.*
  
  Yes
- INFORMATION COLLECTED BY THIS FORM:
  
  Please click the box to the left of each item of information collected if you agree for the information to be collected: *
- First & Last Name GDPR Consent*
  
  First and Last Name
- Email GDPR Consent*
  
  Email Address
- Address GDPR Consent*
  
  Location (Country)
- Phone GDPR Consent*
  
  Phone Number
- Any additional information GDPR Consent*
  
  Name and location (state) of your college or university
- Yes/No Questions about keeping peaceful vigil GDPR Consent*
  
  Pro-life belief and involvement
- IP Address GDPR Consent*
  
  IP Address
- CROSS-BORDER TRANSFER:*
  
  I consent for 40 days for life to transfer, store, access & use all data provided by me to the U.S.A.
- PROCESSING & USE OF DATA :
  
  Please click the box to the left of each item of information collected if you agree for the information to be collected: *
- Storage GDPR Consent*
  
  Storage
- Access GDPR Consent*
  
  Access
- Review GDPR Consent*
  
  Review
- Analysis GDPR Consent*
  
  Analysis
- Contacting you via:
- Contactin by Email GDPR Consent*
  
  Email
- Contacting by Electronic Messaging GDPR Consent*
  
  Electronic Messaging
- Contacting by Phone GDPR Consent*
  
  Telephone
- Sending info about 40DFL & Mission GDPR Consent*
  
  Sending information about 40 Days for Life and our Mission
- Business purposes GDPR Consent*
  
  Business purposes, such as audits, security and fraud monitoring and prevention, developing new and improved methods, services and products, enhancing, improving or modifying our services, identifying usage trends, determining the effectiveness of our campaigns and operating and expanding our activities.
- COOKIES:
  40 Days for Life uses cookies to collect and analyze certain data. For complete information please click: http://www.allaboutcookies.org/
- Do you agree to the use of cookies?*
  
  I agree to the use of cookies
- ACCESS:
  If you would like to access the personal data that 40 Days for Life maintains about you, click HERE.
  DELETION/ERASURE:
  If you would like to change or delete some or all of the personal data that 40 Days for Life maintains about you, click HERE.
  RETENTION TIME:
  40 Days for Life retains personal data as long as there is an active campaign that is relevant to you; or until you request deletion; or for two years unless you re-consent – a reconsent form will be sent to you when the two year mark is approaching.
  PORTABILITY:
  If you would like a copy of the personal data that 40 Days for Life maintains about you, click HERE. In some cases, there may be a small fee for this service.
- IP MEDIA USE AGREEMENT
  
  Thank you for allowing 40 Days for Life (“40DFL”) to use your name, story, photos, and/or videos (“IP”) for use in 40DFL's various media in furtherance of our Mission ("Purpose").
  
  This Agreement constitutes a current, non-exclusive, royalty-free assignment of any ownership rights that you may have in law or otherwise for the Purpose:
  
  YOU grant and assign to 40DFL all right, title, and interest in and to the IP, and all literary property therein, including all copyrights as well as all renewals and extensions of copyright throughout the world, now or hereafter provided. 40DFL’s rights will thus include, but not be limited to, the exclusive right to publish, adapt, license, copy, transmit, translate, republish, distribute, and sell the IP in whole or in part in any channels and by any method or means currently available or developed in the future. The copyright of use for the Purpose shall be in the name of 40DFL or its designee.
  
  Please sign and date below to confirm your permission for 40DFL to use the IP under the conditions of this Agreement, without further notice, permission, royalties and/or compensation to you.
  
  You confirm that you have all rights to the IP and are not infringing on any third-party rights connection with the IP.
  
  You may revoke this permission at any time in writing. Such revocation will be effective from the date of your revocation forward but shall not affect or limit uses then in effect.
  
  Thank you.
- Name of Parent or Guardian if a Minor
  
  First NameLast Name
- Signature*
- Date*
  
  MonthDayYear
  Date
- All applicants will be considered.
- Should be Empty: