MOON’s BRIDGE SCHOLARSHIP APPLICATION

MOON's BRIDGE SCHOLARSHIP APPLICATION

Moon’s Bridge, Inc. will award (2) $250.00 annual scholarships to a graduate of an accredited
Occupational Therapy Assistant program upon review of final transcript depicting a minimum of a 3.50
GPA.

All fields marked with an asterisk (*) are required

PARENT NAME:

MAILING ADDRESS:

DAYTIME TELPHONE NUMBER:

EMAIL ADDRESS:

CHILD’S DATE OF BIRTH:

GENDER:

CUMULATIVE GRADE POINT AVERAGE (GPA) :

ARE YOU THE FIRST PERSON IN YOUR FAMILY TO GO TO COLLEGE?

NAME and LOCATION of OTA COLLEGE (200 chars left)

NAME of CONTACT/NUMBER OF A PERSON OF REFERENCE

(If your resume answers one of these questions, please attach it.)

A. List any academic honors, awards, and/or membership activities while in OTA college
B. List your hobbies, outside interests, extracurricular activities and college related volunteer activities:
C. List your non-college sponsored volunteer activities in the community:

Attach resume

SUBMIT AN ESSAY OF 500 – 700 WORDS STATING 3 PERSONAL CAREER GOALS FOR THE NEXT 5 YEARS (700 chars left)

STATEMENT OF ACCURACY FOR APPLICANT

I hereby affirm that all the above stated information provide by me is true and correct to the best
of my knowledge. I also consent that if chosen as a scholarship winner my picture may be taken
and used to promote Moon’s Bridge, Inc. scholarship program.
I hereby understand I will not submit this application without all required attachments and
supporting documentation. Incomplete applications or applications that do not meet the criteria
with not be considered for this scholarship.

SIGNATURE of APPLICANT

Date

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MOON's BRIDGE SCHOLARSHIP APPLICATION

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