Matthew Debono Memorial Scholarship Program Guidelines

THE PROGRAM

The Matthew Debono Memorial Scholarship Fund was established 25 years ago by the Debono family whose son, Matthew, died from aplastic anemia. Matthew was a student at Wabash College in Indiana when he became ill. He regretted not being able to complete his college education so he and his brother conceived of a scholarship to help students similarly challenged by bone marrow failure disease. Todate, 35 students affected by bone marrow failure diseasehave received scholarships to continue their education in college, university or vocational school programs. In 2011, the Debonos partnered with the Aplastic Anemia & MDS International Foundation, whichis administering the scholarship program. One-year scholarships are offered for study at an accredited institution of the student’s choice. Awards are granted without regard to race, color, creed, religion, sexual orientation, gender, or national origin.

The Aplastic Anemia MDS International Foundationprovides answers, support and hope to patients and families living with aplastic anemia, myelodysplastic syndromes (MDS), paroxysmal nocturnal hemoglobinuria (PNH), and related bone marrow failure diseases.

ELIGIBILITY: Applicants to the Matthew Debono Memorial Scholarship Program must be:

  • High school seniors or graduates who plan to enroll, or students who are already enrolled, in a full-time or part-time(minimum six credits) undergraduate or graduate course of study at an accredited two-year or four-year college, university, vocational-technical school, or graduate school.
  • Diagnosed with a rare bone marrow failure disease: Aplastic Anemia, MDS, or PNH. A physician’s letter stating the applicant’s diagnosis will be required. Applicants do not have to be undergoing current treatment, and may have had a bone marrow transplant.
  • A United States resident under the age of 35

Those who previously received scholarship awards under either the Debono or Harry Carson Scholarship programs are eligible to apply.

AWARDS: Scholarship awards will range from $500 to $2000 for one year. Awards will be granted to multiple recipients.

APPLICATION

Interested students must complete the application and send it electronically to long with a current, complete transcript of grades, a reference, a physician’s letter and the required essaysbyApril 1, 2012.

Previous Harry Carson Scholarship recipients should notethat the essay question you are to complete on the application differs from what is required of first-time applicants.Essays must be submitted as a separate attachment in an MS Word document. Grade reports are not acceptable. Online transcripts must display student name, school name, grade and credit hours earned for each course, and the term in which each course was taken. Applicants will receive an email acknowledging receipt of their application. If acknowledgment is not received within two weeks, applicantsshould contactMichael Breuer.

FEBRUARY 2012
APPLICATION (continued)

Applicants are responsible for gathering and submitting all necessary information. Instructions for completing the Financial Data section of the application are included here. Applications are evaluated on the information supplied; therefore, answer all questions as completely as possible. Incomplete applications will not be evaluated. All information received is considered confidential and is reviewed only by the Aplastic Anemia MDS International Foundation.

SELECTION OF RECIPIENTS: Scholarship recipients are selected on the basis of:

  • Academic record/honors
  • Financial need including current cost of education information
  • Essays:
  • 1st time applicants - Goals and Aspirations, Unusual Personal or Family Circumstances
  • Previous Harry Carson Scholarship winners - Story of Hope
  • Work experience
  • Demonstrated leadership
  • Participation in school and community activities
  • Outside reference
  • Physician’s letter stating applicant has or had a rare bone marrow failure disease
  • Prior and current scholarship awards
  • Under age 35 and living in the United States

Recipients will be selected from a pool of qualified applicants by the Aplastic Anemia MDS International Foundation. All applicants agree to accept the decision as final.Applicants will be notified by May 30th. Due to limited funds, it is unlikely that all applicants to the program will receive a scholarship.

PAYMENT OF SCHOLARSHIPS: Students must accept or reject their scholarships in writing within ten days of receiving notification of an award. Payments will be made by August 15th, 2012. Checks will be mailed to each recipient's home address, and made payable to the school for the student.

OBLIGATIONS

Recipients are required to notify the Aplastic Anemia and MDS International Foundation of any changes in address, school enrollment, or other relevant information that affects the award. Those receiving scholarship awards should be willing to attend regional events associated with the Foundation and interact with the media. You may also be asked to distribute a press release and organizational literature, or write a story for our web site and publications. Submission of your application grants AA&MDSIF the permission to publish and promote your story, and use your name and photograph in association with this scholarship fund, unless you ask us to keep your participation confidential through a letter submitted in writing with your application.

REVISIONS:TheAplastic Anemia & MDS International Foundation reserves the right to review the conditions and procedures of this scholarship program and to make changes at any time including termination of the program.

ADDITIONAL INFORMATION: Questions regarding the scholarship program should be addressed to:

Matthew Debono Memorial Scholarship Program

Aplastic Anemia MDS International Foundation

100 Park Avenue, Suite 108

Rockville, MD. 20850

Attn: Michael Breuer - Phone: (301) 279-7202, x111 - Email:

INSTRUCTIONS FOR COMPLETING THE FINANCIAL DATA SECTION OF THE APPLICATION

1.If you have submitted an application for Federal Student Aid to, you need only provide

theEFC (Estimated Family Contribution) they calculated and returned to you on your Student Aid

Report (SAR). Please send a copy of the page of your SAR with your EFC amount as an attachment to

your application.You mayobtainEFC information from the electronic SAR returned to you by FAFSA, or by

calling FAFSA at1-800-4-FED-AID and providing them with your Data Release Number.

If you have notcompleted a FAFSA Application (for Federal Student Aid), then AA&MDSIF will use the information you provide in questions two through twelve to consider your financial need.

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*Please note you do not need to answer questions two through twelve in the financial data section of the applicationif you can provide us with your current EFC (Estimated Family Contribution) number.

This section of the application should be completed by parents, guardians, or by the applicant if independent. Information may be from the most recently filed tax return; however, provision of 2011 tax information is preferred if possible.

  1. Independent is defined as one who is not claimed as a dependent by the parent/guardian for tax purposes. Information should be from a completed tax return filed with the IRS.
  2. State of Residence is the state where the parents and/or (independent) applicant reside and pay state income tax.
  3. Adjusted Gross Income can be found on IRS FORM 1040 and is gross income reduced or increased by specific adjustments allowed by law.
  4. Total Federal Tax Paid includes the total amount of federal income tax to be paid as reported on IRS FORM 1040. This is not the amount withheld from employee’s paychecks. (The amount withheld should be adjusted by any refund or additional taxes due because of additional income.) Do not report state income tax.
  5. Total Income of parent(s) should be reported individually for both parents if applicant is a dependent student, or by the applicant if independent. Provide information for both natural parents, when possible. If the student resides with only one parent, financial information must be received from the parent who claims the child as a dependent for tax purposes. If a parent has remarried, the spouse’s information is required if the spouse is a legal guardian of the student, or claims the student as a dependent, or the student is included in the spouse’s benefit plan. If necessary, two Financial Data sections may be submitted by the student. A copy of the Financial Data section may be made in order for one to be completed by each parent.
  6. Untaxed Income and Benefits include any other income or benefits not included in the adjusted gross income figure. Do not include untaxed contributions to retirement plans.
  7. Medical and Dental Expenses include only those expenses not paid by insurance. Do not include premium payments.
  8. Total Cash, Checking, Savings, Cash Value of Stocksincludes liquid assets that can be used for educational expenses. Do not include IRA, 401K, or other retirement plan funds.
  9. Total Number of Family Members living in the household and primarily supported by the reported income includes dependent college students living away from home.
  10. Marital Status is the current status of the person from whom the financial information is submitted.
  11. Total Number of Family Members Attending College includes all family members in the household attending a two-orfour-year college, university, or vocational-technical school at least half-time. Be sure to include the applicant in this number.

NOTE: Any exceptions to providing financial information as instructed above must be submitted to the Aplastic

Anemia and MDS Foundation in writing via email to .