THE GREEN FAMILY SCHOLARSHIP

APPLICATION FORM

Each year, up to five recipients are chosen to receive an award of a $1,500.00 scholarship to cover the cost of tuition, book fees and other course fees for the period of one academic year. The scholarship is to assist individuals in gaining and furthering their higher or technical education. The scholarship will be paid directly to the school of the recipient’s choice upon confirmation that the student has enrolled. Each scholarship will be carefully selected by a committee that determines the recipient(s) of that scholarship.

For more information and to review the full list of requirements, please visit: https://ilbcdi.org/get-involved/scholarships/

Full Legal Name *

Phone *

Email *

Have you been diagnosed with a congenital or acquired chronic bleeding or congenital clotting disorder? *

Have you attended a scheduled visit with a federally-recognized Hemophilia Treatment Center in the state of Illinois within the 24 months prior to the application deadline? *

Have you maintained a 2.5 or higher Grade Point Average (GPA)? *

Please upload your official transcript with proof of your GPA. *

Please submit proof of enrollment or intent of enrollment as a full-time student at an accredited vocational/trade school, junior college, or four-year college/university. *

Please upload your scholarship application essay. *

Please upload your resume. *

Please upload your first (1/2) letter of recommendation. *

Please upload your second (2/2) letter of recommendation. *

I acknowledge that submission of an application does not guarantee an award. Scholarships are awarded without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability, or age. The BCDI Foundation reserves the right to modify, suspend, or terminate the scholarship program at any time and is not responsible for delays, errors, or incomplete applications. I acknowledge that the BCDI Foundation, its officers, directors, and agents shall not be liable for any injury, loss, or damages arising from participation in the scholarship program or use of scholarship funds. All information submitted will become the property of the BCDI Foundation and will be kept confidential, unless prior consent has been obtained.

HIPAA Authorization & Consent: I authorize BCDI to receive, access, and review the documents and information I submit with this application, including diagnosis and treatment confirmation and any related personal health information, for the purpose of verifying my eligibility and administering the scholarship.