Scholarship Application
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| Please select the scholarship: |
Please select the desired scholarship. |
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| Applicant Status |
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| Last Name (*) |
Please provide your Last Name. |
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| First Name (*) |
Please provide your First Name |
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| Middle Initial |
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| Maiden Name |
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| Present Address (line 1) (*) |
Please add a value for Present Address (line 1). |
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| Present Address (line 2) |
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| Present City (*) |
Please add a value for Present City. |
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| Present State (*) |
Please select a value for Present State. |
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| Present Zip Code (*) |
Please add a value for . |
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| Permanent Address (line 1) (*) |
Please add a value for Present Address (line 1). |
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| Permanent Address (line 2) |
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| Permanent City (*) |
Please add a value for Present City. |
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| Permanent State (*) |
Please select a value for Present State. |
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| Permanent Zip Code (*) |
Please add a value for . |
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| Email Address (*) |
is not a valid e-mail address. |
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| Telephone Number (*) |
Please add a value for Telephone Number. |
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| Country of Citizenship (*) |
Please add a value for Country of Citizenship. |
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Date of Birth
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| Month (*) |
Please add a value for your Birth Month. |
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| Day (*) |
Please add a value for your Birth Day. |
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| Year (*) |
Please add a value for your Birth Year. |
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| Resident of Florida? |
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Education (High School, College, or University) List all attended:
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| High School Name (*) |
Please add a value for . |
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| Location (City, State) (*) |
Please add a value for . |
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Years Attended
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| Diploma |
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| GPA |
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| GED |
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| Year Attained |
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College #1
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| School Name |
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| Location (City, State) (*) |
Please add a value for . |
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Years Attended
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| Degree Earned/Expected |
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College #2
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| School Name |
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| Location (City, State) (*) |
Please add a value for . |
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Years Attended
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From
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| Degree Earned/Expected |
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College #3
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| School Name |
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| Location (City, State) (*) |
Please add a value for . |
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Years Attended
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From
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| GPA |
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| Degree Earned/Expected |
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| Honors Received (Include dates presented) |
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Expected date of graduation
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| Month (*) |
Please add a value for your Birth Month. |
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| Day (*) |
Please add a value for your Birth Day. |
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| Year (*) |
Please add a value for your Birth Year. |
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| Extracurricular Activities (Include employment, volunteer work, offices held in professional organizations.) |
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Financial Need
Please give a % breakdown of how your expenses are covered (should total 100%). Take into consideration tuition, housing, meal plan, living expenses, etc.
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| % contributed (example: contributions from parents, prepaid tuition plan) |
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| % borrowed (example: student loans) |
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| % earned (example: student contributions from working/employment) |
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| % scholarship (example: any scholarship received, Bright Futures) |
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| Other scholarship aid received (example: any contributions that do not fit the above categories) |
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| How many dependents do you have (including yourself)? |
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| Estimated annual family income |
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| Are you employed during school? |
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| Hours Per Week |
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| Do you work when out of school? |
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| Hours Per Week |
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| Additional information you would like for us to consider |
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| Please write a brief statement of your professional goals and reason for choosing the field of Dietetics |
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OFFICIAL TRANSCRIPTS
Please provide an official transcript from each college and/or university you have attended to the scholarship chair. Transcripts must be received by the scholarship deadline. Please have them sent to Lori Johnson, lorinelson7@gmail.com. If official digital transcripts are not available contact Lori for a mailing address.
REFERENCE FORMS
Request one (1) Florida Academy of Nutrition and Dietetics Foundation Scholarship Reference Form. Reference Form will be submitted online. THE REFERENCES MUST BE FROM:
- a registered dietitian or
- a faculty member
Please have one reference that is a Registered Dietitian or a Faculty Member complete the form through the link on the scholarship home page.
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Electronic Signature (required). Please check this box if you agree your information is accurate. FAND is not responsible for any information not provided. |
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