Lorna Myers PNES Scholarship Application

All materials are due to Epilepsy Alliance America by 11:59pm ET on April 30, 2025 for consideration for awards to be made in June, 2025

Lorna Myers PNES Scholarship Fund

Scholarship Purpose
To assist an individual with PNES with his or her academic and/or vocational training.

Applicants must
• have a diagnosis of PNES confirmed by a statement from the applicant’s physician;
• have proof of acceptance as a full-time student to a post-secondary academic or vocational program;
• submit a completed application including an essay and letters of reference

Note: Previous recipients of the Lorna Myers PNES Scholarship are not eligible to apply.

Dates and Deadlines
Application due date: April 30, 2025
Awards Announcement:  By June 15, 2025

If you have any questions about the application process, please email us at [email protected].

Checklist

Complete the Application using the form below.

To complete your application you will need the following:

  • Personal Essay
  • Verification of acceptance into an accredited school or vocational program
  • School Transcript
  • Copy of last year's IRS filing (first 2 pages of 1040 only)
  • Resume (if available)

You can also submit your health care provider form and your two letters of recommendation directly.
Or, your health care provider and recommenders can submit directly to Epilepsy Alliance America.

Recommendations and Health Care Provider Form

Recommendations

You need TWO completed recommendations for your application.
You can EITHER collect your recommendations and send them to us with your application materials OR you can have the people providing your recommendations submit them directly to Epilepsy Alliance America.

If you are collecing your own recommmendations, Reference Form- Lorna Myers PNES Scholarship 2025.
If they are submitting directly to us, please forward this form to the individuals who will be providing your TWO recommendations.

Health Care Provider Form

'Proof' of a diagnosis with PNES / FS is required for your application.
You can EITHER submit a completed form from your health care provider to us with your application OR you can have your health care provider submit them directly to us.

If you are collecting the form, provide this to them to complete and return to you to submit
Provider Statement - Lorna Myers PNES Scholarship - 2025.

If they are submitting directly to us, please forward this form to your Health Care Provider to complete on your behalf.

If you have any questions about the application process, please email us at [email protected].

Scholarship Application

   

    First Name (Required)

    Last Name (Required)

    Date of Birth (Required)

    Home Street Address (Required)

    City (Required)

    State (Required)

    Zip (Required)

    Applicant Cell Phone (Required)

    Applicant Email (Required)

    Parent/Guardian Name (Required if applicant is a minor)

    Parent/Guardian Email (Required if applicant is a minor)

    Parent/Guardian Phone (Required if applicant is a minor)

    Current School Name and Address (Required)

    Next Year School Name and Address (Required)

    Full-Time or Part-Time Student (Required)

    What will you be studying? (Required)

    List all special awards or honors received

    List all school extracurricular activities

    List all jobs and/or work experience

    Personal Statement:
    Please attach an essay, no longer than 350 words, about yourself stating how the diagnosis of PNES has impacted your life. Be sure to include your personal experiences and how you overcame adversity. (.pdf, .docx, .txt)

    School Transcript:
    Please attach your most recent transcript.
    If you are already enrolled in post-secondary school, you can provide that transcript, not your high school transcript. (.pdf, .docx, .txt)

    Verification of acceptance or enrollment at accredited school or vocational program for the coming academic year (Required .pdf, .docx, .txt)

    IRS Filing:
    If you are a dependent, this should be your family’s return. If you are no longer a dependent, it should be your own tax return. This is to verify income. ONLY include the first 2 pages, and please remove social security numbers. (.pdf, .docx, .txt)

    Optional Resume (Optional, .pdf, .docx, .txt)