Reference Form: Lorna Myers PNES Scholarship

This form must be completed by 11:59pm ET on April 30, 2025.

Through this scholarship program, Epilepsy Alliance America seeks to recognized the personal achievements of those impacted by Psychogenic Non-Epileptic Seizures (PNES) / Functional Seizures.  The scholarship provides tuition assistance to be used at a United States based center of higher learning (trade school, university, college) in pursuit of certification, associates, bachelors, masters degree, etc.

Reference
Please included how long you have known the applicant and what you believe the review committee should know about them.

If you have any questions you can reach out to Epilepsy Alliance America directly at [email protected].

Reference Form

    First Name (Required)

    Last Name (Required)

    Street Address (Required)

    City (Required)

    State (Required)

    Zip (Required)

    Email (Required)

    Applicant Name (Required)

    Please share how you know the applicant

    Please share your recommendation of the applicant

    Attachments - If you completed a Health Care Provider form and/or have another document to submit, you can attach it here. (.pdf, .docx, .txt)