Bipolar Lives Scholarship Application

You are applying for the 2010 www.bipolar-lives.com scholarship. This is a cash scholarship of $750.00 USD, to be awarded on July 1, 2010. 

The scholarship will be awarded based on merit and at the sole discretion of the Bipolar Lives judging panel. 

In the event that more than one entry is judged to be of a winning standard, the prize money may be divided equally between the winning entries (for example two prizes of $375.00).

To be eligible you must be over 21 years of age on July 1, 2009, be enrolled or enrolling in a US college, community college, technical college, or trade school.

YOU MUST complete both PART A and PART B of this application form in full, and submit your application by June 1, 2010. 

The winner will be announced July 1, 2010. 

All applicants must submit an original submission as described in PART B.

All applicants must certify their submission is their own creative work and has never been published or submitted elsewhere. 

The award will be made to the person who most eloquently communicates important information about bipolar disorder. 

An essay of 450 - 900 words must be submitted to the Bipolar Lives website, at www.bipolar-lives.com/bipolar-scholarships-entries.html

PART A: Personal Details

NAME ____________________________
(Note: The scholarship check will be made payable to this name, in the event of a winning application.)

STREET ADDRESS: ___________________________________________

CITY, STATE, ZIP: _____________________________
(Note: This is the address the check will be mailed to, in the event of a winning application.)

NAME OF COLLEGE OR OTHER INSTITUTION: ___________________________

MAJOR: ________________________________

GPA: _______________________________

DATE OF BIRTH: ____________________

Publication of winner’s details: The winner’s full name and address will NOT be published. 
However, initials and, state of residence and field of study will be published. 
For example, “E.H. of West Virginia, a nursing student.” 
Please check the box and type your name below to indicate consent to publication of your initials, state, and field of study:

I Agree 
Electronic signature (type full name): ____________________  

PART B

Applicants must submit an original entry. 

Multiple entries may be submitted but each entry must be unique and be accompanied by a separate entry form.

Your entry must be:

1. An original article submitted to the Bipolar Lives website using the entry form at www.bipolar-lives.com/bipolar-scholarships-entries.html
THE NAME OF MY ESSAY is: ______________________  

Intellectual Property Assignment: Upon entry, your submission becomes the exclusive property of www.bipolar-lives.com and may be used to publicize this or future scholarships, or for other promotional purposes as the exclusive content of www.bipolar-lives.com. By checking the box and typing your name below, you assign all intellectual property rights to www.bipolar-lives.com, warranty you are the creator of the work, and indemnify www.bipolar-lives.com against any claims for damages or losses arising from intellectual property infringement. 

I Agree 
Electronic signature (type full name): ______________________  

Instructions: Email this completed form (as an MS Word attachment) and the name of the essay you submitted to sarah@bipolar-lives.com by midnight (EDT), June 1, 2010. 

You MUST use "Scholarship Application" as the subject line of your email. Entries with other subject lines will not be opened. 

Winner will be notified July 1, 2010.