ÿ New Application



THE SONORAN SPINE FOUNDATION SCHOLARSHIPAPPLICATION DEADLINE: MONDAY, April 1, 2013The ASU Foundation and the Sonoran Spine Education and Research Foundation are pleased to announce the availability of the Sonoran Spine Foundation Scholarship for the 2013-2014 academic year. This scholarship is intended for students attending Arizona State University, Northern Arizona University, or University of Arizona, who are involved with their community and/or schools and have overcome obstacles in their life presented by a spinal disorder. The Sonoran Spine Research and Education Foundation (SSREF) is an independent, non-profit organization founded in 2000 for three specific purposes: 1) To support or sponsor educational programs on matters related to the spine. For example, SSREF supports public awareness programs and advocacy groups for spinal disorders ranging from back and neck pain to complex scoliosis. SSREF sponsors the Arizona Spine and Scoliosis Seminar and supports groups such as the Scoliosis Association, both locally and nationally. 2) The SSREF supports spine research activities. Projects of interest include pediatric and adult scoliosis, kyphosis, spine trauma, osteoporosis, spondylolisthesis, degenerative disc disease and work related back injuries. 3) The SSREF Board of Directors is committed to supporting college scholarships annually to students with spinal disorders. This scholarship is made possible by donations received from the general public, patients and vendors who work with Dr. Dennis G. Crandall through research to improve options for treatment available to persons with spinal deformities and injuries.Scholarship Award Amount: $500 Scholarship(s) Awarded per Year: VariesTo be eligible for the scholarship, an applicant must: Be admitted as a full-time student (12 credit hrs/ semester), in any major, at Arizona State University, Northern Arizona University, or University of Arizona.Have a diagnosed spinal disorder. Show involvement in community and/or school activities.Have a demonstrated financial need, as determined by having filed the Free Application for Federal Student Aid Form and having the resulting “Student Aid Report” on file in the ASU Office of Student Financial Assistance). Preferred filing deadline – March 1, 2009.Application Procedure (please submit in this order):Complete the Sonoran Spine Foundation Scholarship Application (2 pages).Attach a typewritten essay (1-2 pages, double-spaced) describing your medical history regarding your spine disorder, how you have overcome obstacles in your life presented by this condition, and how this scholarship will assist in achieving your education and career goals.Attach a separate sheet listing extracurricular activities, honors, employment, and volunteer/community service (include years of involvement).Attach a physician’s statement (on letterhead) of medical diagnosis.Criteria on which the scholarship selection is based:Involvement in community and/or school activitiesPersonal essayFinancial needApplications are reviewed by the Sonoran Spine Research & Education Foundation Selection Committee, and recipients will be notified via US Mail.This application and all required attachments must be submitted and RECEIVED by the deadline at the following address:By US MailBy FedEx/UPS or to Hand DeliverASU FoundationASU FoundationOffice of ScholarshipsOffice of ScholarshipsP.O. Box 2260300 East University Drive, 6th FloorTempe, Arizona 85280-2260Tempe, Arizona 85280-2260Applicant’s name should appear on every page. All applications must be submitted single-sided (including required attachments) in the original application format. Transcripts or letters of recommendation must be included with original application. DO NOT STAPLE any portion of your application materials. Recipients of this scholarship award will be notified via U.S. Mail.INCOMPLETE, LATE, or FAXED APPLICATIONS WILL NOT BE CONSIDERED.For questions regarding this scholarship, please contact the ASU Foundation at (480) 965-2041.THE SONORAN SPINE FOUNDATION SCHOLARSHIP2013 - 2014 Application FormDeadline: Applications must be RECEIVED no later than MONDAY, April 1, 2013Title: FORMCHECKBOX Mr. FORMCHECKBOX Ms. FORMCHECKBOX Mrs.Name: FORMTEXT ????? FORMTEXT ????? FORMTEXT ???ASU ID#: FORMTEXT ??? LastFirstM.I.Local Phone: FORMTEXT ?????Cell Phone: FORMTEXT ?????Or Campus PhoneLocal Address: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?????Street AddressCityStateZipPermanent Phone: FORMTEXT ?????Email Address: FORMTEXT ????? @asu.eduPermanent Address: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?????Street AddressCityStateZipUniversity Attending: FORMCHECKBOX Arizona State University FORMCHECKBOX Northern Arizona University FORMCHECKBOX University of ArizonaCollege/Department: FORMTEXT ?????Major: FORMTEXT ?????Academic level 2013-2014: FORMCHECKBOX Freshman FORMCHECKBOX Sophomore FORMCHECKBOX Junior FORMCHECKBOX Senior FORMCHECKBOX Graduate StudentNumber of Credit Hours Planned (for 2013-2014 academic year):Fall: FORMTEXT ???Spring: FORMTEXT ???Work ExperienceAre you currently employed? FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, where? FORMTEXT ?????Number of hours per week: FORMCHECKBOX Less than 20 FORMCHECKBOX 20 hours FORMCHECKBOX 21-40 hours FORMCHECKBOX 40 or more hoursEthnicity: FORMCHECKBOX Asian/ Pacific Islander FORMCHECKBOX Black FORMCHECKBOX Caucasian FORMCHECKBOX Hispanic FORMCHECKBOX Native American FORMCHECKBOX Other ________________(optional)PLEASE INCLUDE WITH YOUR APPLICATION: (APPLICATIONS MUST BE SUBMITTED SINGLE-SIDED, IN THIS ORDER) Personal Essay:Attach a typewritten statement (1 to 2 pages, double spaced) describing:Medical history regarding your spinal disorder.How obstacles presented by the spinal disorder have been overcome.How this scholarship will assist in achieving your education and career goals. Activities/Honors:Attach a separate sheet listing extracurricular activities, honors, employment, and volunteer/community service (include years of involvement). Documentation:Provide a physician’s statement (on letterhead) of medical diagnosis. Financial Need:All applicants must file a “Free Application for Federal Student Aid” and have the resulting “Student Aid Report” on file at the ASU Student Financial Assistance Office in order to qualify for need-based scholarships.ENTERING FRESHMEN ONLYHigh School Academic Cumulative GPA (non-weighted): FORMTEXT ?????High School: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?????NameAddressCityStateZipCOLLEGE (CONTINUING OR TRANSFER) APPLICANTS ONLYNo. of Credit Hours Completed To-Date: FORMTEXT ???Colleges Attended (other than ASU): FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ?????NameAddressNo. of YearsCredit HoursGPA FORMTEXT ????? FORMTEXT ????? FORMTEXT ??? FORMTEXT ??? FORMTEXT ?????NameAddressNo. of YearsCredit HoursGPA* * ALL APPLICANTS * *CONSENT TO RELEASE RECORDSAmong other rights afforded to me under Federal Legislation commonly known as “The 1974 Family Educational Rights and Privacy Act”, as amended, I understand that I have the right to specify the name of each and every individual to whom my records are released.I further understand that I may waive my right to specify the name of each scholarship donor or scholarship committee to whom my records are released as long as such records are used only in connection with the ASU Foundation Office of Scholarship Development and Administration. I hereby authorize the Office of Scholarship Development and Administration to gather and release all the records maintained by the office concerning me. Such records may contain the following:a.A copy of my unofficial transcript.b.Letters of recommendation bearing specifically on my application for scholarship.c.Other documents and information relating to my academic performance.d.Documents and information relating to my financial status.I understand that if any application information that I provide or that is provided on my behalf is false or misleading, I will not be eligible for any scholarship award, and that any scholarship awarded to me will be revoked and I will need to return any amounts paid to me.Print Name FORMTEXT ?????SignatureDate FORMTEXT ?????This application and all required attachments must be submitted and RECEIVED by the deadline at the following address:By US MailBy FedEx/UPS or to Hand DeliverASU FoundationASU FoundationOffice of ScholarshipsOffice of ScholarshipsP.O. Box 2260300 East University Drive, 6th FloorTempe, Arizona 85280-2260Tempe, Arizona 85280-2260Applicant’s name should appear on every page. All applications must be submitted single-sided (including required attachments) in the original application format. Transcripts or letters of recommendation must be included with original application. DO NOT STAPLE any portion of your application materials. Recipients of this scholarship award will be notified via U.S. Mail.INCOMPLETE, LATE, or FAXED APPLICATIONS WILL NOT BE CONSIDERED.For questions regarding this scholarship, please contact the ASU Foundation at (480) 965-2041. ................
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