You may download the application and mail it back along with all supporting documents required or complete the application online and upload the required documents.

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ONLINE APPLICATION

Application for Scholarship

Central Florida Epilepsy Scholarship Foundation - Merle Evanchyk Scholarship Program Entrance Application

  • Section 1: To Be Completed By Applicant

    (Please Complete All Fields)
  • Please enter your legal name
  • MM slash DD slash YYYY

  • Current / Past School Information

    NOTES: We may request a copy of your transcripts and will need a release if we do. You may wish to include them with your application but not required.
  • MM slash DD slash YYYY
  • Please enter your High School GPA if applying or enrolled in a four year or more degree program
  • Leave blank if you wish to use ACT score
  • Leave blank if you wish to use SAT score above

  • Section 2: To Be Completed By Applicant

    (Please Complete All Fields)
  • (If same as above indicate “same”. If undecided or pre-acceptance please attach a list of schools applied to in order of your preference.)
  • (If you have one already)
  • Enter the type of degree you wish to earn.

  • Section 3: Enclosures

  • Please be sure to include:

    • A maximum 500 words essay.
    • A letter verifying your admission to college, university, or vocational school. If unavailable the address and phone number you supplied for the admission dept. is suitable.
    • A statement of diagnosis for you from you current attending physician accompanied by a signed copy of the Authorization for Non Routine Disclosure for Protected Health Information. Download the PDF HERE, fill it out, sign and re-upload a scanned image or take a photo and upload that.
    • Two letters of recommendation. Example: Your unique qualities, how you have positively dealt with epilepsy as part of your life, and their expectations for your future endeavors. Obtain letters from: teachers, guidance counselors, principal, employer, community leader, etc.
    • A copy of parents/your/caregivers last tax return
    • Proof of residency in the U.S., State of Florida, City. Example: copy of utility bill, drivers license, rent receipt.
    • A current picture
  • Drop files here or
    Max. file size: 256 MB.
      Please upload your: - Essay in .doc format - Letter verifying admission to college - Statement of diagnosis - Two letters of recommendation (can be in same file) - Tax Return Copy - Proof of residency in the U.S., State of Florida, City - Current picture

    • Section 4: Interview

      The Central Florida Epilepsy Scholarship Foundation may at their discretion conduct interviews in person with finalist for awards. If you agree to an interview please check below (student or if under 18 parent/guardian):
    • MM slash DD slash YYYY

    • Section 5: Acknowledgement / Waiver

      We want you, and our investment in you, to succeed. If you are awarded a scholarship, we will request an agreement to be signed with you/parent/guardian regarding the conditions of distribution of funds for, the purchase of books, payment toward tuition, supplies, school fees, etc. and whether payment will be made directly to a school account for you. You will also be assigned a "Mentor" from the Foundation for you to communicate with so we can maintain a relationship with you and assist in any way we can. Upon an award we will also ask for you/parent/guardian to sign the waiver below and mail/fax it back.

    • Waiver to be filled out upon acceptance

      Download PDF