Shane Leone Memorial Scholarship

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Shane Leone Memorial Scholarship The Shane Leone Memorial Scholarship provides financial assistance to students in New York State affected by kidney disease or related conditions seeking higher education. Scholarship preference is given to graduating high school seniors but consideration will also be given to existing college students. To be considered for this scholarship, you must: Eligibility Criteria 1. Be a resident of New York State 2. Be an upcoming high school graduate accepted in to an approved, accredited two or four year institution 3. Be an existing student in good academic standing at an accredited two or four year institution 4. Be affected by kidney disease or a related condition 5. Have a demonstrated financial need 6. Have a cumulative GPA of 3.0 or higher Selection Process The scholarship committee will consider the following criteria in making their selection: 1. Academic achievement 2. Financial need 3. Letters of recommendation 4. Statement of educational goals and career objectives Deadline to Apply Applications must be received by April 1, 2018. Notification of Awards Award letters will be mailed by May 15, 2018. Varies based on availability of funds. Number of Awards

Amount of Awards Varies based on availability of funds Payment of Award Payment of the award will be directed to the student s academic institution unless extenuating circumstances exist and can be documented. Payment will be made in no more than two disbursements. Scholarship Duration The Shane Leone Memorial Scholarship is a renewable scholarship for a maximum of four years, but students must submit a new application each year to be considered. Funding in one year does not guarantee funding in subsequent years. To maintain eligibility, you must maintain a GPA of 3.0 or higher. Revocation of Scholarship This scholarship may be revoked by the Northeast Kidney Foundation s Board of Directors for any of the following reasons: 1. Students placed on academic probation by the college may be retained on scholarship for one term (semester or quarter). If at the end of this term, they are not removed from probation by the college or university, the scholarship and future payments are automatically revoked. 2. Students suspended from the college for academic or other reasons will have their scholarship automatically revoked, effective the date of suspension even though they may be re-admitted by the college. 3. Any misconduct which would bring discredit to the image of the scholarship, the Northeast Kidney Foundation and the Leone Scholarship Fund. How to Apply Application and required documents should be mailed to: Shane Leone Memorial Scholarship Fund c/o Northeast Kidney Foundation 22 Colvin Avenue Albany, NY 12206 Phone: (800) 999-9697 ext 2 Fax: 518-458-9690 info@healthykidneys.org

Shane Leone Memorial Scholarship The Shane Leone Memorial Scholarship provides financial assistance to students in New York State affected by kidney disease or related conditions seeking higher education. Scholarship preference is given to graduating high school seniors but consideration will also be given to existing college students. To be considered for this scholarship, you must: Eligibility Criteria 7. Be a resident of New York State 8. Be an upcoming high school graduate accepted in to an approved, accredited two or four year institution 9. Be an existing student in good academic standing at an accredited two or four year institution 10. Be affected by kidney disease or a related condition 11. Have a demonstrated financial need 12. Have a cumulative GPA of 3.0 or higher Name: Address: Phone: Email: Are you a graduating high school senior? (yes or no) Name of high school: Location: Date of expected graduation: Approximate GPA: SAT Scores (verbal) (math) ACT Score National Honor Society? Other Awards or Academic Recognition:

Community Service Activities: College you will attend next year: Location: Major: --------------------------------------------------------------------------------------------------------------------- Current college students only: What college do you currently attend: Are you an undergraduate or graduate student? What is your accumulated GPA? Campus Activities/Community Service: Academic Recognitions: --------------------------------------------------------------------------------------------------------------------- Financial disclosure: I intend to work while in school (yes or no) How many hours per week? I plan to have a vehicle while in college (yes or no) Please indicate monthly vehicle expense: Amount of personal cash or savings: My parents will assist me financially while attending college? (yes or no)

My parents are married divorced separated Number of dependent children living at home: Ages: How many will attend college next year? Total parental income: Please provide a schedule of all household expenses, including any academic expenses for yourself and other dependents: Rent/Mortgage Vehicle Payments: Insurance (home, health, vehicle): Property Taxes: Credit Cards: Food: Gas (for vehicles): Other: (please detail): What are your college expenses: Registration/Tuition/Other Fees: Room and Board: Books, Supplies: Other Expenses: (please detail)

Other forms of financial assistance you will be receiving (please detail): I attest that the information contained herein is accurate. Signature Date Please submit this application along with: High school or college transcripts listing your cumulative GPA Three letters of recommendation from teachers, employers, guidance counselors, etc. A copy of your parents previous year income taxes if your parents are providing financial support If your parents are not providing financial support, a copy of your own income taxes if applicable An essay outlining your educational goals, career objectives, and your connection to kidney disease or a related condition. Essay must be type written and be no more than 500 words in length. A photo Return to: Shane Leone Memorial Scholarship Fund c/o Northeast Kidney Foundation 22 Colvin Avenue Albany, NY 12206 (518) 458-9690 (fax) (800) 999-9697 ext 2 (phone) email info@healthykidneys.org