The Teresa Haven Scholarship for Students with Disabilities Application Form – ATHEN (Access Technology Higher Education Network)

Applicant Information

Name(Required)

First Name Last Name

Preferred Pronouns

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Enter Email Confirm Email

Disability (optional)

Applicant Academic Information

Year of graduation from high school (if less than 5 years ago)

Enrollment Status(Required)

I am currently registered at a postsecondary institution in the United States

I have been admitted and plan to register at a postsecondary institution in the United States

What Quarter/semester and year of admission are you registered?(Required)

What quarter/semester and year of admission are you expecting to register?(Required)

Institution and Accompanying Degree Information being pursued(Required)

Institution

Major/Minor

List the postsecondary institutions in the United States along with majors and minors that you are pursuing.

Formal Education After High School(Required)

Institution

Attend From (Year)

Attended To (Year)

Cumulative GPA

In chronological order of attendance, list all your formal education after high school, including all colleges, universities, technical training, and other comparable academic education along with your cumulative GPA at each institution. For all institutions listed below, attach transcripts or email to [email protected]. Unofficial transcripts are acceptable.

Personal Statements

Educational Pursuits and Goals(Required)

Write an overview of your educational pursuits and goals. If you aspire for future academic study or a specific career, discuss your plans. (1,000 words or less)

Past Formal and Informal Experiences(Required)

Describe your past formal and informal experiences, including work, community or student activities and leadership positions. (1,000 words or less)

Letters of Support

Ask two people to write a letter of support for your application. It may be helpful to your references if you provide them with a copy of your personal statements. Letters of support must be emailed by the author of the letter to [email protected] by the deadline date. Applications will not be considered for the scholarship without letters of support.

Contact Information for Letter Writers(Required)

Name

Email Address

Please list the names and email address of the individuals you’ve asked to write a letter of support for this scholarship.

Required Documents

The applicant is responsible for ensuring that all items are submitted to ATHEN by the deadline date. Incomplete or late submissions will not be considered for the scholarship. The application packet should include the following:

Completed application form.
Transcripts of all postsecondary grades (unofficial transcripts are acceptable) must be emailed to [email protected].
Two letters of support (to be emailed by references to [email protected]).

Step 1 of 5

Applicant Information

Applicant Academic Information

Personal Statements

Letters of Support

Required Documents