Bryce Cosdon Scholarship Fund Application

Bryce Cosdon Scholarship Fund Eligibility Requirements*

Bryce Cosdon Scholarship Funds will be awarded in the amount of $1000 to one selected applicant that is a Qualified or General Member of Autism Moms of Kona. Scholarships are awarded based upon financial need, student academic potential and engagement, participation in community activities, and letters of recommendation or nomination.Applicant must be a resident of the Big Island of Hawaiʻi.Applicant must be entering or enrolled in a public, charter, or private school in Hawaiʻi.Applicant must demonstrate attendance of 75% or more of the days in the school year.If an IEP exists, letters of recommendation must be submitted by all key members of the IEP and/or SFT team.Copy of IEP and most recent Progress Report or Report Card is required.A submission, either by caregiver or nomination from a supporter of this individual, must be submitted with minimum 500 words: "My Inspiration for Humanity", describing how this candidate has the opportunity to rise above their current situation to maximize their potential to the best of their cognitive ability. Submission should include a proposal for the usage of funds that demonstrates an advancement in opportunity for the individual. Essays should be typed and double-spaced.If claiming financial hardship, a copy of the most recent tax return, a recent pay stub from both caregivers, or a copy of the most recent bank statement will need to be submitted with the caregiverʻs name on said proof of financial hardship documentation.Applicant must upload a recent photograph (for promotional purposes).

Applicant:*

Full Legal Name

Date of Birth:*

MM/DD/YYYY

Name of Contact Person:*

Full Legal Name

Best Phone Number:*

Ex. (XXX) XXX-XXXX

Please upload a recent photograph of applicant (preferably head and shoulders). Please note, if you are selected as a recipient, this image may be used in promotional communications regarding the Scholarship Program.*

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Email Address:*

Email

Mailing Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Select One:*

I am an Active & Qualified Member of Autism Moms of KonaI am a General Member of Autism Moms of KonaI am a Pending Member of Autism Moms of KonaOther

Name of School*

School Name

Grade*

Grade Level

Please upload a copy of the most recent report card, progress report, or IEP*

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Please upload a verification of school attendance rate , which must be 75% or higher*

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Letters of Recommendation

In addition to the Essay Submission, please provide a minimum of 2 formal letters of recommendation or nomination. These may be from a teacher, guidance counselor, mentor, coach, doctor, family member, caregiver, community supporter, speech therapist, occupational therapist, physical therapist, behavioral interventianist, RBT or BCBA. Letters should indicate the relationship to the Applicant as well as profession, and provide a contact phone number and email for follow-up. Click NEXT to upload your letters.

Click to attach Letter #1*

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Max Total Upload Size: 500MB

Click to attach Letter #2*

Upload a File

Max Total Upload Size: 500MB

Click to attach Letter #3

Upload a File

Max Total Upload Size: 500MB

Click to attach Letter #3

Upload a File

Max Total Upload Size: 500MB

500 - 1000 Word Essay: "My Inspiration for Humanity"

A submission, either by caregiver or nomination from a supporter of this individual, must be submitted with a maximum 1000-word count (minimum 500 words): "My Inspiration for Humanity", describing how this candidate has the opportunity to rise above their current situation to maximize their potential to the best of their cognitive ability. Submission should include a proposal for the usage of funds that demonstrates an advancement in opportunity for the individual. Essays should be typed and double-spaced. Click NEXT to upload your essay submission.

Click to attach your essay submission to this application.*

Upload a File

Max Total Upload Size: 500MB

Scholarship Terms and Conditions

Certification and Release Authorization. I/We certify that this information is complete and accurate. I/We authorize the release of this information to confirm and/or verify this application. I/We further grant unto the Ava Sofia Foundation DBA Autism Moms of Kona, the right to use my name and likeness in connection with the promotion of the Bryce Cosdon Scholarship Fund on, but not limited to, our website, email distribution, and social media platforms. I/We understand that this promotion may be shared by other sponsors and/or community supports which will in turn be used to further the funding opportunity for future scholarships for additional individuals.

I certify that I meet the eligibility criteria for the Bryce Cosdon Scholarship Fund, and have attached IEP/Report Card, verification of school attendance rate, essay submission, and a minimum of 2 written recommendations. I understand that applications that are incomplete, late, or not submitted in accordance with directions will be ineligible for consideration.

I hereby apply for the Bryce Cosdon Scholarship Fund. I understand if I am selected to receive this Scholarship, Autism Moms of Kona has no legal liability or obligation to me other than the payment of the Scholarship Award on my behalf to the approved allocation of funds which will be signed, agreed upon by both caregiver and Autism Moms of Kona, in advance of award approval.

I have read and agree to the Scholarship Terms and Conditions.

Signature*

Signature Date:*

MM/DD/YYYY

This award dated 4/18/2024 was pledged at the Neon Lights Fundraising Event at Samʻs Hideaway to be determined by 25% of the proceeds earned at said event. The final amount of this Scholarship Fund has been vetted and approved by the Board of Directors of the Ava Sofia Foundation DBA Autism Moms of Kona, a local 501(c)3 Nonprofit on the Big Island of Hawaiʻi.