National AMBUCS™, Inc is a national service organization dedicated to creating mobility and independence for people with disabilities by performing community service, and by providing AmTryke® therapeutic tricycles to children with disabilities.

Since 1955, AMBUCS has granted over 12,000 scholarships through the AMBUCS Scholarships for Therapists Program. Funds for this program are provided entirely by local chapters and private donations. The Scholarships for Therapists Program began due to the work therapists do with people and children with disabilities. Today, AMBUCS' Scholarships for Therapists Program is the largest private single source of educational grants for therapists in America.

The program is open to students who are U.S. citizens at junior level in college or above. Students must be enrolled in an accredited program by the appropriate health therapy profession authority in physical therapy, occupational therapy, speech-language pathology or audiology and must be able to demonstrate financial need. Approximately $175,000 is awarded annually.

To apply, complete the empty boxes on your screen. It's that simple!

PLEASE NOTE: While this electronic application is designed to provide extra convenience and time savings for both you and the scholarship provider, it is essential that you do not rush through the application. You will be competing with highly qualified students from across the country who are also seeking scholarship funds. TAKE YOUR TIME AND BE AS ACCURATE AS POSSIBLE.
PLEASE REMEMBER TO PRINT A COPY OF YOUR COMPLETED APPLICATION BEFORE YOU HIT THE "APPLY NOW" BUTTON!

***NOTE:  SSL and PGP encryption are used to submit your information securely.

A. Qualifications

1. The objective of "Scholarships for Therapists" is to enhance direct therapy services to people with disabilities by providing financial assistance to students for professional trainings in the following fields of clinical therapy:
• OCCUPATIONAL THERAPY
• PHYSICAL THERAPY
• SPEECH LANGUAGE PATHOLOGY
• HEARING AUDIOLOGY

  Assistant programs are not eligible.

2. To be eligible for consideration, applicant must:
1. Be a citizen of the United States
2. Document financial need
3. Document good scholastic standing.
4. Be accepted at the junior or senior undergraduate, or graduate level in a program which qualifies the applicant for clinical practice in one of the therapy disciplines listed above. The institution to which you are accepted must present a curriculum ACCREDITED by the appropriate health/therapy profession authority.
5. Express an intent to enter clinical practice in chosen field of therapy in the United States upon completion of course of study for which aid is requested.

1. Carefully study the Qualifications listed above to determine your eligibility to be considered for financial assistance.
2. Complete the application form IN FULL and submit to AMBUCS Scholarships for Therapists.
3. A list of students who are selected as semi-finalists will be posted on-line on April 22 at http://www.ambucs.com/Ascholars.htm. Please note that students will not be notified of semi-finalist status by mail. It is your responsibility to check the posted semi-finalist list on-line beginning April 22.
4. If you are named to the semi-finalist list, you will be asked to mail the following documents, marked in the upper right hand corner with your full name and social security number, to AMBUCS Resource Center.  Due to poor production quality, faxes are not accepted.
1. Enrollment certification or acceptance letter from the educational institution to which you have applied. You will be asked to print this form on your local printer at the end of the on-line application process.
   This form is also available at http://www.ambucs.com/pdf/enrollcert.pdf.
2. IRS Form 1040s. The financial sections (E through H) are important components of this application form, and MUST BE COMPLETED IN FULL. Any items not completed must be fully explained in your narrative statement.
3. Personal statement.  A typed statement of not more than one page doubled spaced (at least 10 pt. font) which describes the development of your chosen field of therapy; your plan of study; career plans after graduation; and why financial assistance is needed.
*Do not send supporting documents unless your name is listed on-line (at www.ambucs.com/Ascholars.htm) as a semi-finalist.
5. It is recommended, but not mandatory, that applicants seek sponsorship of an AMBUCS chapter, provided a chapter is located within a reasonable distance of your home or school.

If you are interested in finding chapter sponsorship, you can find a listing of all AMBUCS™ Chapters at http://www.ambucs.com/Apeople.shtml

If you have had communication with a chapter and know that you are going to be chapter sponsored, please enter the chapter name, and/or city and state:

 **Please Note - No commas are allowed. 

Chapter Name:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

If you are club sponsored, you must print out the completed application and give it  to the your sponsoring club.  The club will also ask for copies of your supporting documents referenced above.

 Do not contact AMBUCS Resource Center for local chapter information.  See the chapter listings at AMBUCS web site (at http://ambucs.com) to find local chapter contacts.  Clubs are automatically given leads to local students and they will contact you if interested.

6. It is the students’ responsibility, not the club’s, to submit supporting documents once the student is declared a semi-finalist.  ONLY SEMI-FINALISTS ARE ASKED TO SUBMIT SUPPORTING DOCUMENTS.  All supporting materials for semi-finalists should be directed to the AMBUCS Resource Center:

National Scholarship Committee
C/o AMBUCS Resource Center
P.O. Box 5127 
High Point, NC 27262

7. Applications must be submitted online by midnight on April 15 to be eligible for consideration. If you are considered a semi-finalist, supporting documentation must be received in AMBUCS Resource Center by May 15 for your application to be considered.
8. Notification of Scholarship Committee award decisions are forwarded to applicants in late June. Awards are made for a specific school year, and a new application must be submitted for each succeeding school year.
9. Grants awarded are deposited to the student's credit account with the financial officer of the institution to which the student has been accepted, but only upon receipt of a VOUCHER OF ENROLLMENT AND STATUS for each session (semester or trimester) attended. Vouchers are issued to the student subsequent to that student's acceptance of a grant award.
10. All information contained in this application form and supporting documents is treated as confidential by AMBUCS' Scholarship Committee.

Application

Email Address
Social Security Number:	(no dashes or spaces example: 123456789)
First Name:
Middle Initial:	(Enter a "1" if you do not have a middle initial)
Last Name:
Home Street Address:
Home City:
Home State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Home Zip Code:
Telephone Number:	(numbers only No spaces or dashes, etc example 3368692166)
U.S. Citizen?	Yes  No

 

 

C. Biographical Data

Date of Birth (mm-dd-yy):	(numbers and dashes only)
Marital Status:	Single  Married
Parents' Marital Status:	Single  Married  Divorced

 

D. Educational Data

Institution to be attended during 2005-2006 school year.

School:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Field of Study:	Occupational Therapy  Physical Therapy  Speech Language Pathology  Hearing Audiology  Other

 

Other:

 

 

Note: Assistant programs are NOT eligible.

Degree Sought:

Undergraduate  Masters  PhD

 

Class Status in 2005-2006 year for which you are requesting assistance.

Junior  Senior  Graduate  Internship  Doctorate 

What terms will you be enrolled in the 2005-2006 school year?
(ex: Fall 2005 Spring 2006) Include affiliation and internship time.

Expected graduation date (mm-dd-yy format):

 

 

Please be certain the above information is accurate as it provides the basis for the payment vouchers issued upon award of a grant.

E. Financial Planning

List known or estimated expenses in the 2005-2006 school year.

(round to the nearest whole number - no decimals or commas)

Tuition:	$
Fees:	$
Books and Supplies:	$
Room and Board:	$

 

 

List known or estimated income for school purposes in the 2005-2006 school year.

(round to the nearest whole number - no decimals or commas)

From family (parents, spouse, etc):	$
From other relatives or friends:	$
From personal loans:	$
From own employment:	$
From grants:	$
From scholarships:	$
From military benefits:	$
From hospital or work contracts:	$

 

 

Amount of financial assistance requested for the 2005-2006 school year. Award range is $500 to

$1500. One two-year award of $3000 per year is awarded annually. (round to the nearest whole number - no decimals or commas)

$

Sections F and G

The National Scholarship Committee is charged with the equitable allocation of funds donated by members of National AMBUCS, the majority of whom support, or have supported, the education of their own families (both single and married students) in undergraduate and graduate programs. For decisions fair to all applicants and donors, it must be documented that financial assistance is essential to applicant's continuing education.

Applicants, please tell us whether you are supported by your parents/guardians or if you are declaring yourself a self-supporting student.

If your parents/guardians claimed you to be a dependent on their 2004 IRS Form 1040 (the one filed
by April 15, 2005) OR you are receiving financial support from them or another family member, then you are supported by your parents/guardians and must complete Section F.

If you are not receiving financial support from a family member AND no one claimed you as a dependent on the 2004 IRS Form 1040, you are a self-supporting student.  PLEASE SKIP SECTION F and GO DIRECTLY TO SECTION G.

PLEASE SELECT ONE:

I am supported by my parents (Section F)
I am a self-supporting student (Section G)

All questions must be answered for the application to be considered. Answers, which are incomplete, or omitted, must be explained in the narrative statement.

Complete only ONE section for financial information, either F. or G.

If declared a semi-finalist, you must then submit, IRS Form 1040 from 2004 tax year. If you complete Section F, send your parents tax return as well as your own. If you complete Section G, then send only your tax return.

F. ONLY FILL THIS SECTION OUT if Receiving Parental/Guardian Support and/or Claimed by Parents/Guardian as a Dependent.

If you are a self supporting student, skip this section and go to Section G.

Parents/Guardian's gross income for 2004 tax year:	$
Applicant's gross income for 2004 tax year:	$
Spouse's gross income for 2004 tax year:	$

During school year, for which scholarship assistance is requested, applicant will:

0 Reside with parents  Reside in college housing  Maintain separate housing 

Dependents

Number of dependents whose parents/guardian will claim in tax year for which scholarship aid is being required.

Parents:	0  1  2
Applicant's Spouse:	0  1
Children 12-18:	0  1  2  3 4 5 6 7 8 9
Children under 12:	0  1  2  3 4 5 6 7 8 9
Other adults:	0  1  2  3 4 5 6 7 8 9

 

 

Include applicant (Be sure to include yourself as you fill in the next three questions)

Number of dependents to be supported in college in 2005-2006 school year:

1  0  2  3  4  5  6  7  8  9 

Number of dependents supported in college in 2004-2005 year:

0  1  2  3  4  5  6  7  8  9 

Number of dependents supported in college in 2003-2004 year:

0  1  2  3  4  5  6  7  8  9 

Last tax year applicant was claimed as dependent:

0 2004 2003 2002 2001 2000 1999  1998  1997  1996  1995  1994  1993  1992  1991  1990 

If you have filled this section out, please skip Section G. and continue on to Section H.

G. Only fill this section out if you are a Self-Supporting Student and no one claimed you in 2004 as a dependent.

If you are claimed as a dependent on your parent's Form 1040 tax return, do NOT fill out this section.  Return to section F and complete the parent supported section.  If you have extenuating or unusual circumstances, please describe them in your personal statement.

Income: (round to the nearest whole number - no decimals)

Applicant's gross income for 2004 tax year:

$

Spouse's gross income for 2004 tax year:

$

During 2005-2006 school year applicant will:

0 Reside with parents  Reside in college housing  Maintain separate household 

Dependents

Number of dependents whose applicant and/or spouse will claim in tax year for which scholarship assistance is requested.

Applicant:	1
Spouse:	0 1
Children 12-18:	0 1 2 3 4 5 6 7 8 9
Children under 12:	0 1 2 3 4 5 6 7 8 9
Other adults:	0 1 2 3 4 5 6 7 8 9

 

Include the applicant in your number of dependents in the next three questions.

Number of dependents to be supported in college in 2005-2006 year:

1 0   2  3  4  5  6  7  8  9 

Number of dependents supported in college in 2004-2005 year:

0  1  2  3  4  5  6  7  8  9 

Number of dependents supported in college in 2003-2004 year:

0  1  2  3  4  5  6  7  8  9 

Last tax year applicant was claimed as dependent (enter 4 digit year):

0 2004 2003 2002 2001 2000 1999  1998  1997  1996  1995  1994  1993  1992  1991  1990 

H. Usual Obligations or Circumstances

List unusual circumstances or other financial obligations which affect applicant's need for financial assistance. Expand as necessary in narrative statement.

(Due to software restrictions - no commas, no carriage returns and only 255 characters are allowed.  A character is considered to be anything that takes up a space, including “spaces”.)

I. Educational Loans

How much in student loans do you presently owe?

	None
	up to $9,999
	$10,000 to $19,999
	$20.000 to $29,999
	$30,000 and up

 

J. Activities Information

1. List extracurricular school and social activities:

(Due to software restrictions - no commas, no carriage returns and only 255 characters are allowed.  A character is considered to be anything that takes up a space, including “spaces”.) 

2. List other work or volunteer experience related to your chosen field of therapy.
(Due to software restrictions - no commas, no carriage returns and only 255 characters are allowed.  A character is considered to be anything that takes up a space, including “spaces”.) 

Please be sure you have filled in all of the above information to the best of your ability. When you're ready to submit your application, just check the certification box below and then click "Apply Now!" below. Please print this application out for your records and then click "Apply Now!" below.

I certify that this information is true, complete, and accurate. I authorize release of information about my scholarship award for use by National AMBUCS, Inc. in their public relations programs.

IMPORTANT!!! BEFORE SUBMITTING THIS APPLICATION: It is strongly recommended that you keep a completed copy.  If your email address was entered correctly above, a message will be automatically sent to you with this information.  If you are unsure of your email address or don't have one, you can click on your browser's PRINT button to print the application. (Be sure to do this before clicking "Apply Now" below):