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Apply Online! DUE DATE: FRIDAY, April 23, 2010!
Application Profile
Thank you for your interest in the 2010 UCB Family Epilepsy Scholarship Program. Follow the prompts below to create your profile.
FIRST NAME
LAST NAME
EMAIL ADDRESS
VERIFY EMAIL ADDRESS
CREATE PASSWORD
VERIFY PASSWORD
APPLICANT STATUS (Please check one)
Person with Epilepsy
Family Member or Caregiver
How did you hear about the scholarship?
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Physician
Epilepsy Foundation
EpilepsyAdvocate.com
Epilepsy Advocate Take Change Tour
Epilepsy Advocate Facebook Page
High School Guidance Counselor
Fastweb.com
Scholarship.com
Other