Caregiver Application 2024 Seize Your Education Scholarship Caregiver of an individual with an epilepsy diagnosisA $1000 scholarship will be awarded in this category. A caregiver is defined as a person who regularly assists someone with epilepsy with living tasks that a person without epilepsy would normally be able to do on their own. The applicant can be a family member, friend, volunteer, or paid professional. Required Elements: 1. General application information must be filled out along with the essay question(s) below. 2. A copy of an acceptance letter submitted via email (this may be provided later in the process if not yet received) 3. Two letters of recommendation submitted via email. Application deadline is June 3, 2024. Applicants will be notified of their standing no later than July 31, 2024.Please enable JavaScript in your browser to complete this form.Name *FirstMiddleLastPermanent Address *Zip Code *City, State *Mailing Address (if different than above)Date of Birth *GenderMaleFemalePrefer not to answerCurrent School Name *Current Grade *Phone Number *Email *Essay Question for Caregiver *In one clearly written response, please explain why you should be the chosen recipient for this scholarship. Your answer should include elements of (1) advocacy work you’ve done (how you’ve raised awareness about epilepsy within your core community, such as friends, family members, co-workers, etc.), (2) specific examples of the ways in which you have helped the person with epilepsy, and (3) at least one example of a difficulty or barrier you’ve encountered that directly relates to the caregiving you’ve done and how you overcame or worked through this difficulty.Have you received this scholarship in the past three years? *Yes (you must complete the next essay question)NoPrevious Scholarship Recipient EssaySince you last won this scholarship, please explain to us what newer, more recent types of accomplishments you’ve achieved. Your answer should include elements of (1) newer advocacy work you’ve done (how you’ve raised awareness in ways that you had not when you last won the scholarship, (2) specific and more recent examples of unique or special accomplishments (this can be related to school, work, volunteer work, or special projects, etc.) and (3) at least one more recent example of a difficulty or barrier you’ve encountered and how you overcame or worked through this difficulty.Has a Caregiver assisted in the completion of this application? *YesNoIF so, please provide their name and contact information Which two letters of recommendation will you be submitting? *Member of your epilepsy health care teamSchool OfficialCommunity MemberWork or volunteer work referenceApplicants must choose two from the above four categories and email them to jmirasola@epilepsywisconsin.org before the application deadline of June 3, 2024. Applicant Signature *I certify the information above is true to the best of my knowledge.Note: The check box above will serve as your official signature Submit
