MHA Academic Scholarship Application Scholarship Information The Midwest Hemophilia Association, a 501c3 not-for-profit organization, is proud to offer two MHA Academic Scholarships to qualified students in our bleeding disorders community. It is our sincere hope that this resource will assist our community members to improve their quality of life through education. Each scholarship is worth $1,500. Two recipients will be chosen to use this scholarship for the upcoming school year. A volunteer scholarship committee will review all applications and determine the winning recipients. The application deadline is June 1st. Applicants will be notified of the decision by July 1st. Qualifications Applicant must be a member of Midwest Hemophilia Association. The applicant must be a post-secondary student diagnosed with a bleeding disorder and live in MHA’s service area which is defined as all of Kansas and western Missouri. Applicants must either be entering or attending a trade/vocational school, community college, junior college, four-year college, or university. Applications must be submitted by June 1st. Reference Form Instructions REFERENCES – Applicant must submit two references. One form should be completed by an educator, principal, or school staff member. The other form should be completed by a past/current employer, volunteer coordinator, or community leader. They may not be relatives. (Please use attached reference forms). Please download the two Scholarship Reference Forms below and send one to each of your two references. Each reference must complete their form in full. Once completed, please take a clear photo or scan of each finished form. You will then upload images or files of both completed reference forms as part of this scholarship application. Be sure all writing is legible and all required sections are completed before uploading. Note: Your application will not be considered complete unless both completed reference forms are uploaded. Scholarship Reference Form Educator, Principal, or School Staff Member Download PDF Scholarship Reference Forms(Required) Drop files here or Select files Max. file size: 50 MB. Scholarship Application Applicant Data Name(Required) First Middle Initial Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email(Required) Bleeding Disorder(Required) High School Data Name of High School(Required)Graduation or GED Date (Month)(Required)Graduation or GED Date (Year)(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Principal(Required)School Phone Number(Required)GPA Scale (e.g., 4.0 scale, 5.0 scale, or 100-point scale)(Required)Cumulative GPA(Required)SAT Verbal ScoreSAT Math ScoreACT English ScoreACT Math Score Post-Secondary School Data Name of post-secondary school you plan to attend. (If unknown, please list in order of preference the schools to which applications for admission have been sent.) List(Required)SchoolCityState Add RemoveSchool Type(Required) 4-year College or University 2-year Community College Trade School Other Academic Year for the Upcoming School Year(Required) 1 2 3 4 5 Graduate Study Major or Course of Study(Required)Anticipated Date of Graduation (Month)(Required)Anticipated Date of Graduation (Year)(Required) Activities, Awards, & Honors List all school and/or community activities in which you have participated during the past four years. List all special awards, honors, and offices held. Separate high school and college activities.(Required) Goals & Aspirations Write a statement of your plans as they relate to your education and career goals.(Required) Essay Submission Each applicant must submit an essay. It may be as long or short as the applicant desires. You may use the box below to type your essay OR submit the completed essay using the file upload option below. Here is the essay prompt: Everyone applying for this scholarship has a bleeding disorder. What sets you apart from the others to deserve this scholarship?Essay File SubmissionMax. file size: 50 MB. Application Completion Requirements This academic scholarship application is considered complete when all of the following have been submitted: Student application Student essay Two reference forms (1 educator/principal/school staff member and 1 employer/volunteer coordinator/community leader) In submitting this application, essay, and references, I certify that the information provided is complete and accurate to the best of my knowledge. Falsification of information may result in termination of any scholarship granted. Once submitted, all documents become property of Midwest Hemophilia Association. Date(Required) MM slash DD slash YYYY Signature(Required)
