Scholarship submission

Name of applicant with SB *

First Name

Last Name

Address *

Permanent address of Wisconsin residence.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing address *

This should be the address where we will mail the check. Usually the registrar's office. Include building and office number.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Statements of understanding for this submission *

I understand that my submission does not guarantee a scholarship award and that priority consideration is given to new applicants.

I understand that if awarded a scholarship, I must provide a thank you statement and photo via email to SBWIS and grant permission for use on their website and social media.

I understand and will favorably respond to future requests from SBWIS for testimony about the impact of our services.

This box is checked in verification that the named applicant completed the responses in this application.

This box is checked in verification that the information provided in this application is true and accurate.

I understand that I must provide these additional documents via scan/email or post mail to SBWIS *

Email to sbwis@sbwis.org or post mail to our office address at the bottom of this website page.

Copy of most recent academic transcript.

Letter verifying enrollment in the listed institution of higher education.

One formal reference letter from a faculty member, teacher, coach or employer (not a family member)

Statement of primary diagnosis of spina bifida from a medical professional.

My personal statement (if not completed in the online application)

How do you keep in touch with SBWIS? *

Checking the website

Following Facebook posts

Newsletter postcard

Email blasts