Scholarship Application, Pink Carpet Foundation

2023 PCF Academic Scholarship Application

Eligibility Criteria

Must have 2.5 cumulative gpa on 4.0 scale Official High School Transcript (6 semesters) Recommendation Letter (Counselor, Teacher, or Principal) Essay Diagnosis Verification Current Photo (appropriate headshot, appropriate clothing, no pouty lips, hand gestures, etc.) Completed Online Application by January 31, 2023

Applicant Contact Information:

Name *

First

Last

Address Field *

Address Line 1 *

City *

State *

Zip Code *

Email Address *

Cell *

Birthday *

Gender *

Male Female

Upload Photo *

Select Image

only jpg, png, gif or pdf are accepted

Education:

High School Name *

High School Address *

Address Line 1

City *

State *

Zip Code *

Extra-curricular and community activities, honors, awards received during high school *

College you plan to attend *

Anticipated Major *

Upload Official Transcript *

Select File(s)

Upload Recommendation Letter *

Select File(s)

On a separate sheet please provide a typed essay (250 - 500 words) answering the questions below:

How did the breast cancer diagnosis of your loved one affect you? Discuss in your essay the challenges or obstacles you have faced and overcome or is struggling with as a result of the diagnosis. How will this scholarship help you succeed beyond high school? Be authentic in your writing.

Upload Essay *

Select File(s)

Breast Cancer Diagnosis Verification

Name *

First

Last

Relationship to Applicant *

Date of Birth *

Address (if different from applicant) *

Address Line 1

City

State

Zip Code

Date of Diagnosis *

Survivor *

Yes No Ongoing Treatment

Upload a copy of your personal diagnosis letter on medical letterhead by your oncologist, primary physician or nurse to only reflect the above mentioned. Please redact any information not wished to be viewed by the PCF Scholarship Committee. *

Select File(s)

Parent(s) or legal guardian(s) Contact Information:

Name *

First

Last

Parent Cell/Home Phone *

Parent Email *

STATEMENT OF ACCURACY FOR APPLICANT

Please check by each statement *

I hereby affirm that all the above stated information provided is true and correct to the best of my knowledge. I also consent that if chosen as a scholarship winner my picture may be taken and used to promote the scholarship program. I hereby understand that if chosen as a scholarship winner, according to the Pink Carpet Foundation Scholarship Committee, I must be present at any potential awards ceremony or reception to receive my scholarship award. I hereby understand I will not submit this application without all required attachments and supporting information. Incomplete applications or applications that do not meet eligibility criteria will not be considered for this scholarship.

STATEMENT OF ACCURACY FOR PARENT

Please check by each statement *

I hereby affirm that all the above stated information provided is true and correct to the best of my knowledge. I also consent that if chosen as a scholarship winner my picture may be taken and used to promote the scholarship program. I hereby understand the medical information provided may be used by PCF for the sole purpose of eligibility criteria for the Pink Carpet Foundation Scholarship and shall not be released to any entity without my written consent in accordance to HIPAA Act 45, C.F.R. 160, 164.

Date *