
click here for printable PDF application form
| 1 | The student must be physically challenged and may be "chair-confined" but does not have to be. The physical challenge must be significant. No minor disability will be considered. |
| 2 | Must have serious financial difficulties. |
| 3 | Must have a at least a B+ average. |
| 4 | Must be a high school senior or college freshman. We do not fund graduate studies. (No one over age 21 should apply--our "charter" does not permit it.) |
| 5 | The applicant must show some form of major community service or social contribution in the past. |
ALL APPLICANTS WILL BE CONSIDERED WITHOUT REGARD TO SEX, RACE, or CREED.
Fifteen to twenty new students are taken yearly and are given $3,000-5,000 per year for each college year to a maximum of $20,000 total. About 150 applicants apply yearly.
| NAME: AGE: SEX: |
| ADDRESS: |
| TYPE OF DISABILITY: |
| ARE YOU A HIGH SCHOOL SENIOR? OR COLLEGE FRESHMAN? |
| PHONE: E-MAIL ADDRESS: |
You must include:
Please send your application by February 15th. Your application will be reviewed and if anything is missing, we will contact you. The deadline for submitting application information is February 28th. No e-mail applications will be accepted.
Mail completed applications to:
ChairScholars Foundation Inc.
ATTN: Hugo Keim, M.D.
16101 Carencia Lane
Odessa, FL 33556