Meningitis Angels Heaven and Earth Bound, Inc.
Po Box 448 Porter, Texas 77365 
Office Phone 281-572-1998 ~ 24 Hour Hotline 713-444-1074

E-Mail  ~ MeningitisAngels@aol.com 
Web Site www.meningitis-angels.org

Scholarships are funded in amounts according to resources and time of active service each year. They are paid directly to the educational facility and not to any one individual. The board can take up to 45 days to respond. 
All decisions are final. 

Please print and mail completed form to the address above.

Application Instructions and Requirement

Application Deadline for Consideration April 1 of your senior year.

If you are applying for this scholarship:

1.      You must be able prove you are a survivor of vaccine preventable bacterial meningitis (Hib, Pneumococcal or                  Meningococcal. This can be done with a certified written letter from the attending physician or a copy of medical            records including diagnosis. Photos are encouraged which show any proof.

2.      You must have been an active verifiable member of the Meningitis Angels program for at least (2) year service                prior to high school graduation. 

3.      You must be a graduating senior of the year applying.

4.      Amount of scholarship will depend on funds available and how many qualifying

         applicants received scholarships in the current year.

5.      The following application must be completed in full in hand printed or typed word and

          submitted by mail no later than April 1, of your graduating year. Scholarship is then

          reviewed by the board of directors as to eligibility of requirements met. 
               
 6.      Make sure all attachments ask for are included. Failure to do so could result in a delay or denial of scholarship.
          You must sign the bottom of this document and have notarized.


Name______________________________________________________________________

Age_______________________ Type of Meningitis ________________

Address____________________________________________________

City/Town _______________________, Zip Code__________________

E-Mail Address______________________________________________

Home Phone _________________________Cell Phone______________

Name of High School Graduating From ___________________________________________

Class of ____________________ Honors Yes____ No____ List _______________________

Address_____________________________________________________________________

City/Town__________________________________________ Zip Code__________________

Don’t forget to include the required information outlined in #1 on this application.

 

How long have you been Active Member of Angels? _____________

 

Please provide a proven detailed list of your activities creating meningitis awareness in your school and/or community.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Please provide detailed list of fundraising activities for Angels you have participated in.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Please provide a detailed list of service to Meningitis Angels

I.E. chat rooms, message boards, advocacy, state team leader or etc.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Academic

Please provide a legal copy of your high school transcript.

Please provide a list of other Community/School/Church Activities

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Written Essay (On a separate sheet of paper type in your own words) a one page essay on

•   What has being apart of the Meningitis Organization has meant to your life.
•   What your degree/career  plan is. 
•   Do you plan to and how can use this education to continue meningitis awareness?
•   List any scholarships or grants you have/are received/receiving, the amount, and destination of  those, i.e. tuition, books, room and board etc.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 Agreement


I, (print name) _________________________________ hereby swear I have completed the following application

with complete truth and fact.

I, give permission for Meningitis Angels to video/photograph my receipt of any scholarship

which might be awarded to me. 

I understand this video/photo will be used in any and all

Publications of Meningitis Angels including but not limited to all web, written and visual media.


Sign _______________________________ Date______/_____/20____

Applicant Signature

___________________________________

Parent/Legal guardian if above is under 18 years of age.

 

Witness 

I, _______________________________ certify, that I witness the signature herein and swear to my knowledge all content and attachments to be true.

Date______/_____/20____  Signature _____________________________

Scholarship Application