Dr. Alan J. Saffran Scholarship Application

Student Information
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
U.S. Citizen*
- YES
- NO
Parent or Guardian Information
Deceased Parent/Guardian's Name*
First Last
Living Parent or Guardian's Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Sibling Information
Please include the name and age of each sibling
Personal Reference Information
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email*
Relationship to Applicant*
Student's Educational Information
High School*
*
City State
Honors
Community/Extracurricular Activities
Offices Held
College*
Intended Major*
Expected Start Date*
Expected Graduation Date*
Financial Need
Current Household Annual Income
Short Essay
1 to 3 paragraphs about the impact your parent's or guardian's death has ad on your life and family, how you have persevered, and your goals for the future.*
Additional Documents
• Please attach a copy of your most current high school transcript.
• Please attach 1-2 letters of recommendation from a teacher, counselor, coach, minister or adult mentor who knows you well.
Max. file size: 128 MB.
Max. file size: 128 MB.
Max. file size: 128 MB.
Student and Parent/Guardian Affirmation
Both student and parent/guardian must read and accept the following statement.

We affirm that the information on this application is accurate, true and complete to the best of our knowledge. We understand misrepresentations may constitute fraud, which may result in the loss of eligibility of this scholarship or other legal consequences. We give permission to the selection committee of the Dr. Alan J. Saffran Scholarship Fund to review student transcripts and other personal information provided.
*
- Accept

To submit by mail, please download the application below and mail with all additional documents to:

New Hope for Kids
Dr. Alan J. Saffran Scholarship Application
544 Mayo Ave.
Maitland, FL 32751

PRINT APPLICATION (pdf)

scholarship@newhopeforkids.org

Dr. Alan J. Saffran Scholarship Application

Student Information

Parent or Guardian Information

Sibling Information

Personal Reference Information

Student's Educational Information

Financial Need

Short Essay

Additional Documents

Student and Parent/Guardian Affirmation