Achieve Your Dream Fund Application, page 1

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* First and Last Name of Applicant

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* Address

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* City

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* State

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* Postal/Zip Code

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* First and Last Names of Parent(s)/Guardian(s)

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* Parent/Guardian Address

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* Parent/Guardian City

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* Parent/Guardian State

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* Parent/Guardian Postal/Zip Code

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* Parent/Guardian Email

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* Applicant Email

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* Parent/Guardian Phone Number

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* Applicant Phone Number

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* Applicant Date of Birth

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* Are you a member of DSACT?

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* Please list ways you or your family members have volunteered with DSACT, if any.

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* Please list programs/courses for which you would like to use the Achieve Your Dream funds. Please include cost.

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* Scholarship Amount Requested

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* Previous Education - Please begin with the most current educational programs and include for each: 
1. College/High School Program/City
2. Start/End Dates
3. College Courses/Vocational Courses/Program Courses
4. Level of Completion

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* Employment/Community Service/Volunteer History - Please include the following for each term of service:
1. Name of business/organization
2. Dates of employment/service
3. Title/Description of Duties

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* List favorite hobbies, sports, and activities

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* Have you participated in DSACT programs? If yes, which programs?

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* Do you participate in Special Olympics? If yes, what sports?

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* Please list extracurricular activities, clubs, special honors, and awards you have received

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* If you do not receive funding from Achieve Your Dream, are you financially able to take the Program/Course for which you are applying?

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* I understand that I am applying for a scholarship to help me to continue studying at or to enroll in a college program or vocational program. The information provided in the application is my own work and represents my thoughts. If I am selected to receive this scholarship, I am aware that I will need to provide documentation as to how and where the money will be spent. I verify that I meet the following requirements: I have Down syndrome; I am at least 18 years of age; I intend to continue studying or enroll in a post secondary program or enrichment course.

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* Typing your full first and last name in the spaces below is your agreement to the statement and is binding like your handwritten signature.

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* Date Completed

Date

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