COLLEGE OF HEALTH & HUMAN SERVICES SCHOLARSHIP PROGRAM ANNEMARIE PELLERITO SCHOLARSHIP INFORMATION SHEET WHO IS ANNEMARIE PELLERITO? Annemarie was the strongest, sweetest, and most special young lady. She knew only unconditional love and acceptance of people and animals. Her entire life of twenty-nine years was a battle with neurofibromatosis (NF), and often times debilitating genetic neurological tumor disorder. Despite the time she spent coping with NF and its many intrusions in her life—she had twelve major surgeries and countless other procedures—Annemarie never let the disorder that ravaged her body define her. She was a warm, determined person who strove to the best of her abilities with humor and grace. She never gave up and never gave in! Annemarie was a natural horsewoman, winning multiple gold medals in riding and jumping at the Special Olympics Equestrian, culminating in 1998 with the award for Most Inspirational Athlete. People who met her learned from her: lessons of living in the moment, of being adaptable, of keeping spirits high, of self acceptance, of courage. She was a mentor to her older brother and an inspiration to all who knew her. In loving memory of Annemarie (September 15, 1973 - August 7, 2003), the Annemarie Pellerito Memorial Foundation was formed to provide: 1) programs that were important to Annemarie’s quality of life—social and recreational programs that enrich the lives of challenged people and 2) programs such as scholarships and health conferences that support health related professions. The Annemarie Pellerito Foundation Scholarship is created to keep Anne’s spirit alive, to inspire others, and to increase the awareness and understanding of neurofibromatosis. COLLEGE OF HEALTH & HUMAN SERVICES SCHOLARSHIP PROGRAM 2009-2010 APPLICATION Purpose To memorialize the life of Annemarie Pellerito through a scholarship to a CSULB student who has personal experience with or a professional interest in assisting individuals and their families who are affected by chronic life threatening diseases. One (1) Annemarie Pellerito Scholarship ($2,500) will be awarded to an outstanding undergraduate or graduate student. Funds may be used for tuition, fees or books. Eligibility Students must: 1. Have been accepted into a major in the College of Health and Human Services. If a program is impacted, pre-majors will be considered. 2. Have completed at least 75 units at the undergraduate level or completed at least one semester in a graduate program. 3. Have declared their major and have a minimum GPA of 2.75. Application Process 1. Applications are available electronically on http://www.csulb.edu/scholarships, under the “Alphabetical Listing.” Please TYPE the application in Microsoft Word, sign and submit the application, along with all attachments to the Center for Scholarship Information (USU-238) by THURSDAY, NOVEMBER 5, 2009 at 4:00 P.M. 2. Each application should include the following information: General CHHS application form Unofficial transcripts from MyCSULB; if previous academic information is not listed please provide an official transcript from those universities. Personal Statement (no longer than 3 pages, double spaced, 12 pt. font) describing how you or a family member has been affected by a chronic life threatening disease or how you intend to help those with such a condition. Please address your financial need for this scholarship and other achievements you have earned as a student. ****PLEASE PAPER CLIP RATHER THAN STAPLE YOUR MATERIALS**** Criteria 1. Academic excellence as verified in the transcript. 2. Financial need demonstrated on application and in personal statement. 3. Commitment to serving those affected by chronic life threatening diseases as demonstrated in the personal statement. Selection/Notification Process 1. A selection committee of CSULB faculty and staff will evaluate applications and select recipients. 2. The Dean will announce the scholarship recipients in late December, 2009. Recipients are required to write a thank you letter and attend a recognition reception in Spring 2010. Failure to do so will result in forfeiture of the scholarship. If you have questions regarding this scholarship, please contact the Center for Scholarship Information at email@example.com. PLEASE NOTE THAT LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. COLLEGE OF HEALTH & HUMAN SERVICES SCHOLARSHIP PROGRAM 2009-2010 APPLICATION Contact Information Student ID Number: First Name Address: City: Home Phone: E-mail: State: Cell Phone: Date of Birth: Zip: Sex: Last Name Male Female Academic Information Academic Standing: Junior Senior Minor: Graduate Student Major or Graduate Program: Number of Units Currently Enrolled: Cumulative GPA: Expected Graduation Date Number of Units Completed at CSULB: Major GPA: Financial Information Please complete this section on your financial information. Please indicate your living arrangement and state the amount you pay per month: With parent(s) Residence Hall $ $ House/Apartment - Shared House/Apartment – Alone Other: What is your monthly income? How many hours per week do you work? What is your rent/house payment? $ What is the total monthly income of your household (include your income)? $ How many people live in your household? $ $ $ $ PLEASE NOTE THAT LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. COLLEGE OF HEALTH & HUMAN SERVICES SCHOLARSHIP PROGRAM 2009-2010 APPLICATION Are you currently a Presidential Scholar? Are you currently a recipient of any other scholarship: If so, please state the name and amount of award(s). Yes Yes No No Please check to which scholarships you are applying (application form required for each scholarship to which you are applying): Annemarie Pellerito Scholarship Gladdes Neff Soroptimist Award Roger F. Greaves & HealthNet Endowed Scholarships I affirm the information provided above is true and accurate. I understand I may be disqualified if I provide false or misleading information on my application. I understand that my signature allows the administrators to access information such as academic records and use my essay for public purposes. My signature acknowledges that I understand the parameters of the scholarship and, if selected as a recipient, I will write a thank you letter/card to the donor and attend the respective reception. I hereby authorize CSULB and the Center for Scholarship Information to release any and all of the above personal information provided on my application and any attached documentation such as resume, transcript and personal statements to any member or organization involved in the selection of scholarship recipients. I understand that once released the information may no longer be under the control of the University and I release CSU and its employees and agents from any claims, damages or liability which I may have in connection with this scholarship. Signature of Applicants Date Submit completed application to the Center for Scholarship Information (USU-238) PLEASE NOTE THAT LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.