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Letter of Intent (LOI) Instructions for Grant and Scholarship Request to The SAMFund

Thank you for your interest in applying to Surviving And Moving Forward: The SAMFund for Young Adult Survivors of Cancer.  The SAMFund seeks to assist cancer survivors as they move forward with their personal, professional or educational goals.  Applicants must be between the ages of 17 and 35, finished with active treatment and residents of the United States.  We are looking for motivated young adults whose current financial needs are linked, directly or indirectly, to their cancer experience.  After completing the questions below, type your essay at the end of this document (beginning on the first empty page), and email the document back to us at LOI@thesamfund.org. 

Please do not make any changes to the questions below.  If they do not pertain to you, just write “N/A” in the answer field.  LOIs that have any changes made to the questions will not be considered for review.

Completed Letters of Intent must include the following:
° Personal information
° Financial information
° Essay

Personal Information
Name:
    Email address:
Mailing Address:
    Phone number:

Diagnosis:
    Age at diagnosis:

Month/year completed treatment:
    Date of birth:

Financial Information
What is your annual salary or other compensation from employment, self-employment, SSI, etc? 
   
With whom do you live (i.e., parents, spouse, domestic partner, etc)?  If you live with a spouse or domestic partner, what is your annual household income? 
   
What is your monthly rent or mortgage?
   
What other monthly expenses do you have (for example, prescription co-pays, gym or physical therapy, student loan payments, health insurance, cell phone, utilities, car payments, etc.)?  Please list each monthly expense that you are responsible for, and the monthly amount that you pay.
   
Do you receive any other grants, scholarships and/or student loans?  If so, from whom, in what amounts, and for what periods?
   

Please type an “x” on the line below if the following statement is correct:

__  I certify that I am completing this application for myself.

If you are NOT the applicant, and are completing this on someone’s behalf, please explain your relationship to the applicant and why you are completing this application for him or her.  Please note: the applicant must submit his/her own application unless s/he is physically or cognitively unable to do so.


Essay Section

Essays must be no more than two pages, double spaced, in 12 point font with one-inch margins.  Essays that do not fit these formatting requirements will not be reviewed.
Please submit a brief essay (beginning on the next page of this document) that answers the following questions:

• Tell us, briefly, about your cancer experience. 
• What are you requesting funds for, and why?
• How are your financial needs related to your cancer experience?


Applicants must answer ALL these questions in order to be considered for application. 

Please submit your Letter of Intent by 5:00 pm EST on Friday, July 30th, 2009 by emailing it to LOI@thesamfund.org.   The SAMFund will notify you by August 7th, 2009 if you have been selected to submit a full application.