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2025 Scholarship Application
ELIGIBILITY
Applicants must meet all three of the following criteria to be considered for a Susan Fund scholarship:
Be a current resident of Fairfield County, Connecticut
Have been diagnosed with cancer at some time in one's life
Be planning/attending an accredited post high school institution of higher learning
PERSONAL INFORMATION
Name
First Name *
Middle
Last Name *
Birth Date
Month
January
February
March
April
May
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August
September
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November
December
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Cell Phone
Preferred Email
Best method to contact you:
Text cell phone
Preferred email
Home Address
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Home Phone
College Address if Currently Enrolled
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Côte D'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic Of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic Of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States Of
Moldova (the Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Martin
Saint Pierre And Miquelon
Saint Vincent And The Grenedines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province Of China
Tajikistan
Tanzania, United Republic of
Thailand
The Federal Democratic Republic of Nepal
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Address Line 1
Address Line 2
City
State/Province
Postal Code
College Phone
College Email
FAMILY INFORMATION
Parent/Guardian Information
First Name *
Last Name *
OCCUPATION
PARENT/GUARDIAN EMAIL
Parent/Guardian Information
First Name
Last Name
OCCUPATION
PARENT/GUARDIAN EMAIL
Dependents (List brothers, sisters or other relatives who are financially dependent upon your parents or yourself)
FIRST & LAST NAME, BIRTH DATE , OCCUPATION/SCHOOL , SCHOOL COST
EDUCATIONAL INFORMATION
SCHOOL
EXPECTED YEAR OF GRADUATION
SCHOOL TRANSCRIPT
Your most recent school transcript from High School or College is required as part of your application. The transcript can be uploaded and attached to this application.
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Email Transcript
If you are unable to upload your transcript at this time, please email your transcript no later than April 1st to SUSANFUND@GMAIL.COM with your name in the subject line.
Sending Transcripts to SUSANFUND@GMAIL.COM
GOALS
Write a statement of your educational or career goals.
FINANCIAL INFORMATION
Parents' Total Annual Income
Applicant's Annual Income
CURRENT EDUCATIONAL COST & SUPPORT (2024-25)
TOTAL EDUCATIONAL COST FOR 2024-25
AMOUNT OF FINANCIAL SUPPORT RECEIVED FROM:
Parents/Relatives
Scholarship/Grants
Loans
Self
Other
TOTAL Financial Support (Please add up amounts from above)
TOTAL AMOUNT OF LOANS OUTSTANDING
ANTICIPATED EDUCATIONAL EXPENSES FOR THE COMING YEAR (2025-26):
Tuition
Room
Board
Books
Supplies
Travel
TOTAL 2025-2026 Anticipated Expenses (A)
AMOUNT OF FINANCIAL SUPPORT YOU EXPECT FROM (2025-26):
Parents
Relatives
Scholarships
Loans
Self
Other
TOTAL Financial Support (B) (Please add up amounts from above)
*Note: Total 2024-25 Anticipated Expenses (A) MUST EQUAL Total Financial Support (B)
2025 LETTER OF RECOMMENDATION (a new one is required every year)
Letter of Recommendation
A current letter of recommendation from your employer or school authority is required as part of your application. The letter can be uploaded and attached to this application by choosing the upload delivery method below.
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Email Letter of Recommendation
If you are unable to upload your letter of recommendation at this time, please email your letter of recommendation no later than April 1st to SUSANFUND@GMAIL.COM with your name in the subject line.
Sending Letter of Recommendation to SUSANFUND@GMAIL.COM
Describe your work and volunteer experience over the past 12 months
Describe your family's financial circumstances
MEDICAL INFORMATION - Please explain the nature of your illness
Doctor's Statement
If you are a first time applicant, you must submit a statement from your doctor describing the nature of your illness. Past recipients are encouraged to submit a current doctor's statement. Please choose one of the delivery methods below or indicate that you will not be submitting a doctor's statement.
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Email Doctor's Statement
Sending Doctor's Statement to SUSANFUND@GMAIL.COM
Not required to submit a Doctor's Statement
Not required to submit a Doctor's Statement
How did you become aware of The Susan Fund Scholarship Program?
Additional Pertinent Data
You or your parents are encouraged to include any additional pertinent data in support of your application.
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VERIFICATION AND RELEASE
CURRENT PHOTO
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Email CURRENT PHOTO
If unable to upload your photo at this time, please email it no later than April 1st to SUSANFUND@GMAIL.COM with your name in the subject line.
Email CURRENT PHOTO
Applicant's Electronic Signature
Date
Month
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Electronic Signature Acceptance
I ACCEPT
By entering your Name and Date and checking off the "I ACCEPT" box below, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.
PUBLICITY AUTHORIZATION: Applicant's Electronic Signature
The recipient of a Susan Fund scholarship understands that receiving such a grant may result in publicity, and hereby authorizes The Susan Fund to publicize or use the recipient’s name and/or photograph, now or in the future, in promotional material involving The Susan Fund. The recipient hereby releases and holds harmless The Susan Fund and its Board of directors from any and all liabilities, damages or claims of any kind resulting from the use, distribution of disclosure of the recipient’s name and/or photograph or other information regarding the recipient.
Date
Month
January
February
March
April
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Electronic Signature Acceptance
I ACCEPT
By entering your Name and Date and checking off the "I ACCEPT" box below, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.
Who We Are
Meet Susan
The Fund Today
Board of Directors
Frequent Questions
Contact Us
News
News
Sona Kocinsky, 2024 Reception Speaker
The Susan Fund Podcast
The Susan Fund: 4 Decades of Changing and Celebrating Lives Blog
Celebrating Susan: Staples High School 1980 Reunion
Ann Lloyd--Unsung Hero
Video Gallery
Photo Gallery
Join Our Mailing List
Scholarships
Our Scholarships
Eligibility
Application Process
Apply
Recipients
2024 Recipients
2023 Recipients
2022 Recipients
2021 Recipients
Donate
Who We Are
Resources
Apply
Get Our Newsletter