BEF SCHOLARSHIP GRANT APPLICATION FORM

Personal Information     Family Information  
First name: ……………………....   Father’s name: ………………………….

Last name:
………………………		   Academic institution(s) attended:
………………………….
Prefix: Mr.__ Mrs.__   Mother’s name: ………………………….

Birthdate:
____/____/____		   Academic institution(s) attended:
………………………….

Country of Citizenship:
……………………....		   Father’s profession: ………………………….
Social Security Number: ……………………....   Mother’s profession: ………………………….
Have you applied for a grant before?
Yes__ No__		     Please provide a W2
form for verification
Did you receive one? Yes__ No__     for both parents.
Gender: Male__ Female__   Number of siblings: ………………………….
      Ages of siblings: ………………………….
Contact Information     Candidate Education Fill where applicable
Email: ……………………....   High school: ………………………….
Address: ……………………....   Location: ………………………….
Address: ……………………....   Dates attended: ………………………….
Address: ……………………....   Overall G.P.A. ………………………….
Telephone: ……………………....   Estimate rank in class: ………………………….
Have you ever been convicted of a crime?
Yes__ No__		   Undergraduate College:
………………………….
If yes, please explain on
a separate page.		    
Dates attended:
………………………….
      Overall G.P.A. ………………………….
      Declared major: ………………………….
Testing Information Please send ETS receipt of all scores   Essay Question
SAT total score & %: ……………………....   Discuss your post graduation goals.
Verbal score & %: ……………………....   Please limit your essay to one page double spaced.
Math score & %: ……………………....    
Essay: ……………………....   In addition, in one paragraph, explain what schools
Other ETS tests taken: ……………………....   you were accepted to and why you chose the one
For Graduate Level Only:     did. Please provide us with the acceptance letter.
GMAT, GRE, LSAT, MCAT, Other:
………………………		    
Dates taken: ……………………....    
Scores & %: ……………………....    

 

All applicants must provide an official or unofficial high school transcript. Applicants should also enclose a letter from their pediatrician or social worker confirming their cystic fibrosis prognosis. In addition, please provide us with a recent photo of the applicant.

I certify that the information presented in my application is accurate and complete. I understand and agree that any inaccurate information, misleading information, or omission will be cause for the rescission of any grant offered to me. BEF may verify any and all party of my application materials.

 

Date: ____/____/____ Applicant’s signature:__________________________________________