AUTISM NETWORK ME
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Paving the Way
Scholarship Application
Thank you for your interest in the Paving the Way Scholarship. Please complete the following form:
*
Indicates required field
Name
*
First
Last
Birthdate
*
Street Address
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City/Town
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State/Zip Code
*
Phone
*
Email
*
Last School/Year Attended
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Employment History
*
Desired Institute of Higher Learning (along with address)
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Desired Program of Study
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Short Essay: How will your chosen program of study help you to become an independent functioning adult?
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Short Essay: What has been the biggest challenge that you've overcome regarding your diagnosis?
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Describe three of your favorite interests or hobbies.
*
Please include
Proof of Diagnosis
along with
two Letters of Recommendation
from non-family members and
mail them to:
Autism Network ME
Paving the Way Scholarship
PO Box 3
Waterville, ME 04903
SUBMIT
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