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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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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| 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
Have an Official Transcript for each college or university attended sent to the FAND Headquarters to be received on or before November 9th, 2018.
Mail Official Transcripts to
Scholarship Chair
The Florida Academy of Nutrition and Dietetics Foundation
P.O. Box 12608
Tallahassee, FL 32317-2608
Phone: (850) 386-8850
Fax: (850) 386-7918
Email: cstapell@eatrightflorida.org
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.
SCHOLARSHIP APPLICATION, OFFICIAL TRANSCRIPTS, AND REFERENCE FORMS MUST BE RECEIVED ON OR BEFORE NOVEMBER 9, 2018.
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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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