Scholarship Application Scholarship Application Have you downloaded the application, read and understand the instructions?* Yes, I have Full Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Cell Phone*Name of College* GPA or SAT scores* What is your major?* What is your career interest?* Student acknowledgement* I agree.By checking below, I acknowledge that all information I have provided in this application is true, complete and accurate. I understand that the decision of the selection committee is final and may not be appealed. I agree to release the Kisses for Kyle Foundation, its directors, officers, and employees, from any and all claims and/or disputes of any kind whatsoever, arising out of or relating to this application and/or any items provided to the Kisses for Kyle Foundation with or relating to this application. Furthermore, if selected as a scholarship recipient, I grant consent to the Kisses for Kyle Foundation to include my name, image, and story in all promotional materials related to this scholarship and the work of the Foundation. Beyond the classroom activity #1 - listed in order of importance to you* Year(s) you participated* School Year or Summer Hours*School YearSummerHours per week* Weeks Per Year* Position held* Activity #2 (if applicable) Year(s) you participated School Year or Summer HoursSchool YearSummerHours per week Weeks Per Year Position held Activity #3 (if applicable) Year(s) you participated School Year or Summer HoursSchool YearSummerHours per week Weeks Per Year Position held Activity #4 (if applicable) Year(s) you participated School Year or Summer HoursSchool YearSummerHours per week Weeks Per Year Position held Activity #5 (if applicable) Year(s) you participated School Year or Summer HoursSchool YearSummerHours per week Weeks Per Year Position held Please type your essay here:*If you choose to send the option video instead of writing an essay, please notate that in the essay field and email your video to info@kissesforkyle.orgSchool Letter of Recommendation*Max. file size: 300 MB.Please follow instructions on downloaded applicationTreating Physician* Title Hospital Affliation* Hospital Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Copy of Physician's Letter*Max. file size: 300 MB.High School transcripts or SAT scores*Max. file size: 300 MB.Proof of college enrollment or admission letter for upcoming term*Max. file size: 300 MB.Most Recent Financial Aid Award LetterMax. file size: 300 MB.Copy of your Student Aid ReportMax. file size: 300 MB.Applicant's E-Signature* First Last Date MM slash DD slash YYYY Δ