Application for a Scholarship K
Grant
Eligibility:
Scholarship K Grants are awarded
to deserving individuals who have demonstrated a genuine concern for the
welfare of others through volunteer work in their community and who
intend to pursue a college education in a medical or scientific field.
The Kevin Kitchnefsky Foundation for Spinal
Cord Research does not award cash grants. When a Scholarship K Grant is
awarded, the Foundation pays the monies directly to the educational
institution noted on your application, or, if your school of choice has
not yet been determined, we will make the payment once you submit your
choice in writing.
Your application must be accompanied by official documentation that
verifies the projected costs associated with your course of study.
Goal: To encourage students to pursue careers in medical or
scientific fields. Instructions:
Print and fill out this application completely. Use additional paper for
the essays, then attach them to the application and mail to:
Kevin Kitchnefsky
The Kevin Kitchnefsky
Foundation for Spinal Cord Research
109 German Hill Road
Tunkhannock, PA 18640
Privacy:
Please note that your information will be kept private and not sold or
shared with any other organization. You may, from time to time, be
contacted by The Kevin Kitchnefsky
Foundation for Spinal Cord Research regarding events, volunteer
opportunities and other Foundation activities.
Questions may be directed to Kevin or Yvonne at (570) 836-1240.
Step One: Submit your Application for review.
Step Two: We will contact you to set up a personal interview with
a designated liaison.
Step Three: Our Board of Directors will review your application
and the report from our liaison's personal visit with you.
Step Four: Our Board of Directors will select the recipients. All
decisions are final.
Required Information:
Name
_____________________________________________________________________
Date of Birth_____________________ Social Security
#___________________________
Mailing
Address______________________________________________________________
City_______________________________ State______________
Zip_________________
Telephone (day)_____________________________________________________
Telephone (evening)__________________________________________________
Email__________________________________________________________ Fax_____________________________________________________
If you are requesting financial assistance from other organizations,
please list them:
__________________________________________________________________________
__________________________________________________________________________
Amount Requested: $_____________
Is this request time-sensitive? (circle one) YES
NO
If so,
explain________________________________________________________________
__________________________________________________________________________
Essay Section:
In 300 words or less, explain why you are interested in pursuing a
medical or scientific degree and how a K Grant would help you accomplish
that goal.
Financial Section:
Please attach a copy of your most recent federal tax return.
Thank you for your interest in receiving a K Grant!
Signature of person filling out this
request_____________________________
Date_____________ |