Lilly-MDAO

Moving Lives Forward Scholarship

Disclaimer and Eligibility

The following information is collected for the use of the selection committee only and will not be shared without written permission of the applicant. Previous recipients of this scholarship are not eligible to apply.

In order to be eligible for consideration for the Lilly-MDAO Moving Lives Forward Scholarship, the applicant must:

  • Be diagnosed with a mood disorder (depression, bipolar disorder, anxiety and other related disorders)
  • Be currently receivingmedication ORreceiving treatment and support such as counseling, case management, group therapy, peer support, etc.
  • Must be enrolled (by September 2013) in an accredited post secondary education institution in Ontario.
  • Complete the application process including all appropriate documentation and references and submit byTuesday April 30th, 2013.

Application Procedure

Part One of Three

Applicant Information

1. Name:______

2. Address:______

3. City:______

4. Postal Code:______

5. Tel:______

6. Email:______

7. Have you previously applied for a Moving Lives Forward Scholarship?

(Circle) YES orNO

If so, in what year?______

8. If you are selected to receive a Lilly-MDAO Moving Lives Forward Scholarship, do you consent to having your name published? Circle) YES or NO

Application Procedure

Part Two of Three

Question Response

Answer each question individually (max. 3 pages total) to the best of your ability.

  1. Please describe your personal history and the background of your illness and diagnosis.
  2. What barriers have you had to face throughout your illness?
  3. Please describe what you have learned about yourself and your illness as you have moved toward wellness.
  4. Please describe the reintegration and/or rehabilitative activities that you are involved in (including volunteer work).
  5. What support systems do you have in place to help you cope in general, and in particular with the stresses of returning to school?
  6. Please describe your goals for your education and plan for achieving these goals.
  7. Please provide the following information about your proposed educational activities:
  1. Name of Educational Institution
  2. Course Name
  3. Length of Course to accreditation or graduation
  4. Have you completed the application process for your chosen course? Yes or No. If no, please explain.

Application Procedure

Part Three of Three

Two references are required for each applicant. A Professional reference and a character reference (not friends or family)are required for this section. Please ensure that your referees provide the following information and responses on a separate piece of paper:

  1. Name
  2. Company/Title
  3. Phone Number
  4. Email
  5. What is your relationship to the applicant?
  6. How long have you known the applicant and in what context?
  7. What role do you play in supporting this person?
  8. Please state why you support this individual in their application.

Application Deadline: Tuesday April 30, 2013

Application Checklist

Incomplete applications will not be considered. You may download and print additional applications at: Before submitting, please ensure the following are included:

Application form

Question Responses (max. 3 pgs.)

References (2 are required)

Sending Your Application

Application Deadline: Tuesday, April 30, 2013

Please email your completed application to:

Scholarship Selection Committee

(Send attachments in MS Word or RTF format ONLY)

If you are unable to email the application, mail it to:

Scholarship Selection Committee

The Mood Disorders Association of Ontario

36 Eglinton Avenue W., Suite 602

Toronto, ON, M4R 1A1

Please do not fax your application.

The Mood Disorders Association of Ontario is proud to offer programs and services that cover a wide range of issues and topics. The programs are designed by and for people with mood disorders, their families and friends.

For more information about our programs, please visit our website or call us.

Tel: 416-486-8046 ext. 300

Toll free: 1-888-486-8236

Email:

Website:

The Mood Disorders Association of Ontario is grateful to Eli Lilly Canada for providing the funding for this scholarship program.

Opening the doors to educational opportunities

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