Disability Resources and Services

Application for the Alice Raefsky Scholarship

APPLICANT MUST TYPE ALL INFORMATION INTO THIS FORM. We will not accept handwritten applications.

Eligibility Criteria

  • Matriculation as a registered Temple student in Academic Good Standing

(You must have attended Temple at least one [1] semester and be enrolled in a program leading to a degree)

  • Registration with Temple University Disability Resources and Services (DRS)

(Please refer to to learn about this process)

  • Filing of a current *FAFSA that establishes financial need
  • *International Students - Consistent with conditions of F1 Status, students are encouraged to advise Office of International Services of any change in financial circumstances. Office of International Services will review your financial situation with you and provide a document to verify changes in your financial circumstances. Please enclose a copy of this document with your DRS scholarshipapplication.
  • Evidence of leadership, persistence and achievement in academics or community service activities
  • THANK YOU LETTER: Successful applicants who receive scholarships must submit a thank you letter to the DRSScholarship Review Committee within four (4) weeks of receiving the award. Submission of a thank you letter is required for consideration for future DRS scholarships.

Application Completion Requirements

  • Type responses to all questions on this form
  • Attach current copy of forms,found in Self Service Banner (SSB) on the TUportal,with your name printed on each form:
  • Financial aid award package for current financial aid year (award overview)
  • Financial aid status for current financial aid year
  • Print out of your active registrations
  • Attach current copy of National Student Loan Data System (NSLDS) Cumulative Loan Statement
  • Sign and date authorization/certification below

Authorization/Certification for the Alice Raefsky Scholarship

Through my signature, I certify that I am eligible for consideration of The Alice RaefskyScholarship and that I meet all eligibility criteria listed. I authorize DRS Scholarship Review Committee to review financial and academic records to verify my eligibility.

PLEASE READ AUTHORIZATION/CERTIFICATION ABOVE, PRINT OUT THE PAGE AND SIGN.

______
NameDate

Submit To:Disability Resources and Services

100 Ritter Annex

1301 Cecil B. Moore Avenue

Philadelphia, PA 19122

Application for the Alice RaefskyScholarship

Date Submitted:
Personal Information
Name: / TUid:
Address:
TempleEmail:
Phone: / Alternate phone:
Your Academic Profile
Your Major: / Expected Graduation Date:
Degree Sought: / Transfer Credits:
Total Credits at Temple: / Full Time/Part Time:
Current Credits Registered: / Cumulative GPA:

Please provide all the following documents

  1. Financial aid award package for current financial aid year (from SSB with your name included)
  2. Financial aid status for current financial aid year
  3. Active registrations (from SSB Student Tab with your name included)
  4. Current Cumulative Loan Statement (from If you encounter difficulties logging into NSLDS, please call 1-800-433-3249.

PLEASETYPE your responses to each of the following questions. Each response is limited to 1,000 characters or less:
1. / What are your educational and career goals?
2. / How will this award help you in meeting these goals?
3. / How is your requestspecifically related to your disability?
4. / Please describe how you have demonstrated leadership, persistence, and achievement in your academics or community service activities.

Application Check List: (please check each item to indicate that you have read and followed the instructions)

Type your responses to all questions on this application

Attach a current copy of all forms from SSB with your name printed on each

Financial aid award package for current financial aid year (award overview)

Financial aid status for current financial aid year

Print out of your active registrations

Attach your current copy of National Student Loan Data System (NSLDS) Cumulative Loan Statement

Read, sign and date the authorization/certification on the first page

If you have questions as you complete your application, please email your questions to and write “Scholarship Application” in the subject line.