Scholarship Application

Please complete the application below in full and hit submit. There will be a rolling notification process based on the start date of the program applied for. Applications must be completed in their entirety in order to be considered. The exact scholarship amount to be awarded will be determined at a later date. As a general rule, scholarships will not be greater than $2,000 and not less than $500. The HSF reserves the right to increase the amount of the scholarship if an exceptional situation exists.

If a scholarship is awarded and you are subsequently reimbursed for services by an outside source such as a school system, insurance company, or other third party payer, you shall repay, in full, the scholarship fund the amount you were awarded. Your submission of this application serves as your understanding of this policy.

Please feel free to follow up with an email to dphartlaw@verizon.net with any questions you may have.

Scholarship Application

Section One: Applicant Information

Name of Applicant(Required)

First Last

Date of Birth of Applicant(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is applicant 18 or older?(Required)

Yes

If you have answered "No" to the question above, the following section must be filled out if you would like us to consider your application.

Name of Parent or Guardian #1

First Last

Relationship to Applicant

Name of Parent or Guardian #2

First Last

Relationship to Applicant

Home Phone of Parent or Guardian

Work Phone of Parent or Guardian

Address of Parent or Guardian

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parents/Guardians or Applicants Combined Annual Household Income(Required)

Less than $15,000

$15,000 – $25,000

$25,000 – $35,000

$35,000 – $45,000

$45,000 – $55,000

$55,000 – $70,000

$70,000 and above

Total number of people living in household dependent on the above income?(Required)

Section Two: Written Statements

TO BE WRITTEN BY THE PERSON SEEKING A SCHOLARSHIP AND/OR PARENT(S) or GUARDIAN(S).

PLEASE WRITE A BRIEF PARAGRAPH INDICATING WHY YOU WISH TO APPLY FOR THE SCHOLARSHIP.(Required)

TO BE WRITTEN BY THE PROSPECTIVE PARTICIPANT:

PLEASE WRITE A PARAGRAPH OR TWO ABOUT WHY YOU WANT TO COME TO THIS PROGRAM. PLEASE TAKE YOUR TIME AND THINK ABOUT YOUR SPEECH AND WHY YOU WANT TO WORK ON IT, WHAT STUTTERING MEANS TO YOU, WHAT YOU ARE HOPING TO GAIN FROM PARTICIPATING IN THE PROGRAM.(Required)