GREATER ATHOL AREA ADVOCATES FOR SPECIAL NEEDS SCHOLARSHIP. in affiliation with The United Arc. GAAAFSN Scholarship Description & Eligibility

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GAAAFSN Scholarship Description & Eligibility The Greater Athol Area Advocates for Families with Special Needs (GAAAFSN) in affiliation with The United Arc announces the establishment of its new scholarship fund. There will be up to four educational awards given in amounts up to $800 per award to cover tuition, books or other student fees. Eligible applicants may apply in their senior or final year of public, collaborative or technical high school or during their freshman and sophomore years of college or post secondary school. Priority will be given to students from communities in the North Quabbin area. Potential grant recipients would include: 1. Individuals with disabilities pursing educational opportunities beyond high school, 2. Siblings of individuals with disabilities, 3. Individuals who have a parent or parents with disabilities, 4. Individuals planning a career that would support people with disabilities, such as careers in education, human services, health care or technology and research with a disability focus Applicants are asked to complete a short application form to be submitted along with one reference and current transcript to the GAAAFSN Scholarship Committee postmarked no later than April 6, 2015. For application materials contact GAAAFSN/The United Arc at 361 Main Street, Athol, MA 01361 978 249 4052 or 413 774 5558 x 1023 email: rebeccahhanna@unitedarc.org. Award recipients will be announced @ the GAAAFSN Annual Meeting on 5/15/2015. Awardees will receive $100 towards books and miscellaneous educational expenses and an additional amount up to $700 to be paid directly to the school based on a letter of acceptance and current bill. 1

Application Form Deadline: Application and all supporting materials must be delivered or postmarked no later than April 6, 2015 to GAAAFSN Scholarship Committee, 361 Main Street, Athol, MA 01331. Selection Criteria: Applications are reviewed by the GAAAFSN Advisory Board. To be considered, an application must be complete, with requested attachments included, and submitted within the deadline. Priority to students from North Quabbin communities. 1. Name: 2. Address: 3. Phone: (H) (C) 4. Email: 5. Is there an alternate person we should be contacting regarding your application? If so, Name: Relationship to You: Phone: (H) (C) Email: 6. Personal Status: (check all that apply) I have a disabling condition (please specify) I received help in completing this application. The person who assisted me is: Name Relationship My parent has a disabling condition (please specify) My sibling has a disabling condition (please specify) 2

7. Students completing High School: a) Which school do you currently attend: b) Anticipated graduation or completion date: c) What college/university or technical/vocational school do you plan to attend? Name of School: City/State: d) What course of study do you plan to pursue? e) Please check the appropriate box below: I plan to enroll in a single course per semester I plan to enroll in a degree or certificate program 8. Current College or Post Secondary Students: a) Which college/university or technical/vocational school do you currently attend: Name of School: City/State: b) When did you enter this school? c) Are you pursuing a certificate or degree? Circle: YES NO d) Anticipated graduation or completion date: e) What is your current major or course of study: 9. School or Community Service, Engagement or Volunteerism: Please list any community service, memberships, or volunteerism that you have done in the past two years: Organization Your Involvement Dates 3

10. Awards, Honors or Recognitions: Please list any academic or non academic recognition, prizes or awards which you have received in the past two years: Organization Your Involvement Dates 11. Essay Questions: Pick one of the questions below and respond on a separate piece of paper a) Tell us about the area of study you hope to pursue after high school (or are currently studying): Why did you choose this area of study and what do you want to do after you complete your studies? b) Tell us how disability has impacted your life. c) Tell us about someone who has had an influence on your life and why they have been influential to you. d) If you could make a change in your school or community what would that change be and why do you want this change to occur. REQUIRED ATTACHMENTS: 12. Teacher or Community Member Recommendation: Please have a teacher or community member who knows you well complete the Letter of Recommendation Form and include this with your application. No recommendations from family members. 13. School Transcript: Students Completing High School: Please include your high school transcript. Students currently enrolled in Post Secondary School: Please include your transcript to date for the your post secondary studies. Recommendation Enclosed Transcript Enclosed 4

The Greater Athol Area Advocates for Families with Special Needs (GAAAFSN) in affiliation with The United Arc announces the establishment of its new scholarship fund. There will be up to four educational awards given in amounts up to $800 per award to cover tuition, books or other student fees. Eligible applicants may apply in their senior or final year of public, collaborative or technical high school or during their freshman and sophomore years of college or post secondary school. Priority will be given to students from communities in the North Quabbin area. Potential grant recipients would include: 1. Individuals with disabilities pursing educational opportunities beyond high school, 2. Siblings of individuals with disabilities, 3. Individuals who have a parent or parents with disabilities, 4. Individuals planning a career that would support people with disabilities, such as careers in education, human services, health care or technology and research with a disability focus Scholarship applicants must submit a letter of recommendation from a teacher or community member with their application. Deadline for applicants is April 6, 2015 (postmark date). For Students: Please give this letter to a person who will be writing you a Letter of Recommendation. Your name: Letter of Recommendation Form Contact information: Phone Email Scholarship Applicant's Name: How do you know this applicant (your relationship)? How long have you known this applicant? On a separate sheet of paper please describe what you know of the above applicant's capabilities and goals for education beyond high school. The scholarship committee is interested in knowing about the applicant's attitude, initiative, academic achievements, community contribution or involvement, character, and personal attributes. Please describe why you think this applicant should receive a GAAAFSN scholarship. For References: Please attach your recommendation letter to this form and return the form and letter to the student to submit with their scholarship application. 5