Scholarship Application 2026 1Personal Information2Educational Information3Medical Eligibility4Financial Information5Personal Statement6Letters of Recommendation7Agreement & Signature CompanyThis field is for validation purposes and should be left unchanged.Applicant's Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Preferred Method of Contact(Required) Email Phone Citizenship Status(Required) U.S. Citizen Permanent Resident Other Current School (High School, College, or Vocational Program)(Required)Expected Graduation Date(Required) MM slash DD slash YYYY Estimated GPA(Required)Intended Field of Study or Program (if known)Have you been accepted into an accredited program?(Required) Yes No Attach Transcript(Required)Accepted file types: pdf, jpg, png, Max. file size: 10 MB. Proof of Acceptance or Enrollment(Required)Accepted file types: pdf, jpg, png, Max. file size: 10 MB. Diagnosis(Required)Date of Diagnosis(Required) MM slash DD slash YYYY Healthcare Provider or Hospital(Required)Healthcare Provider's Name(Required) First Last Healthcare Provider's Email(Required) Medical Attestation Form Copy & email the link below to your medical provider to for them to complete. Once they complete the form, CCF will receive a copy automatically. https://www.childrenscancerfundny.org/medical-attestation-form-2 Annual Household Income(Required) < $50k $50k – $75k $75k – $100k > $100k Household size(Required)Number of Dependents in Household(Required)Number of Dependents in College Simultaneously(Required)Receiving Other Financial Support?(Required) Yes No Other scholarships or grants received or pending? Yes No Please list scholarships or grants.Employer Tuition Assistance? Yes No Family Contributions? Yes No Student Loans? Yes No Optional: Brief statement of financial need (Please describe your financial need and/or What circumstances impact your ability to fund your education) How would you like to submit your personal statement?(Required) Written Essay (500–700 words) Video (up to 3 minutes) Personal Statement Essay(Required)Personal Statement Video Link(Required)Please upload a 3-minute (max) personal statement video to YouTube (Unlisted), Vimeo, Dropbox, or iCloud, then paste the shareable link below. Optional Prompts. You may use one of these prompts for your personal statement. 1. How my journey with a hematology/oncology related illness has shaped my aspirations for the future. 2. The lessons I’ve learned from overcoming challenges and how they guide me today. 3. How I plan to make a difference in my community or chosen field. 4. What hope means to me and how I strive to inspire others. 5. How being a sibling of a hematology/oncology patient affected me personally and shaped my future goals. Provide two letters of recommendation: 1. A teacher, mentor, or employer who can speak to your character, academics, or work ethic. OR A healthcare provider or patient advocate who can speak to your resilience or contributions. 2. A personal letter of recommendation (family, friend, coach, etc.) Please have 2 letters of recommendation emailed to ccfscholarship01@gmail.com or uploaded directly through the application here. Letter of Recommendation #1Max. file size: 10 MB. Letter of Recommendation #2Max. file size: 10 MB. Certification & Consent(Required) I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any falsification may result in disqualification. I also give The Children’s Cancer Fund NY consent to the use of my story, images, or testimonial for promotional purposes, should I be awarded this scholarship.Date(Required) MM slash DD slash YYYY Signature(Required)*If applicant is under the age of 18 at time of submission, parent/legal guardian must sign off on this application.Is the applicant 18 years of age?(Required) Yes No Parent / Guardian's Name(Required) First Last Relationship to Applicant(Required)Parent / Guardian Contact Number(Required)Parent / Guardian Signature(Required)Date(Required) MM slash DD slash YYYY
