Varun Bhaskaran (WAS) Scholarship Application

 

Incomplete forms cannot be processed

First Name:required
Middle Initial:
Last Name:required
Street Address:required
City:required
State:required
Zip:required
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E-mail:required
Date of Birth (mm/dd/yyyy):required
Phone #:requiredinvalid numberrequired
Diagnosis (must be Wiskott-Aldrich Syndrome (WAS) to be eligible):
 
Father's Name:required
Mother's Name:required
Who is the physician who treats the student's primary immunodeficiency disease?required
 
Name of School Which Applicant Will Attend:required
Academic or Career Goal:required
Field of Study:required
Degree or Certification Being Pursued :required

Number of Years or Semesters Already Attended: required choose one:

Previous Degrees (including dates received):required

What is your main source of Income? choose one:
Will your parents be able to contribute any financial aid to your education? choose one:
If yes, how much ? required per choose one:
If no, please explain:
required

Identify all scholarships, loans, grants, etc. applicable towards your education:
required

Please estimate your personal out-of-pocket expenses for the school year including tuition, books, fees, and room and board:
required

Have you received an IDF scholarship in the past years? choose one:
If yes, when? required

If you are awarded an Varun Bhaskaran (WAS) Scholarship, will you give permission to print your name and state in the Immune Deficiency Foundation's Advocate Newsletter? choose one:


How did you hear about the Varun Bhaskaran (WAS) Scholarship Program of the Immune Deficiency Foundation?
required


Please upload the following documents. Documents may be in pdf or jpg format but should be no larger than 2MBs.

Click here for additional information about supporting documents

Autobiographical Essay:
file required
Letter from student's immunologist:
file required
Documentation of enrollment acceptance for current school year:
file required
Letter of Recommendation #1:
file required
Letter of Recommendation #2:
file required
FAFSA application or Federal Student Aid Report:
file required
 
VERIFICATION OF REQUIREMENTS

By checking this box, I verify that I meet the IDF Scholarship requirements. required