Undergraduate College Scholarship Application
The Kelsey B. Diamantis TS Scholarship Family Foundation, Inc.
d/b/a Dollars 4 Tic Scholars

Application for Fall 2019

Your completed application along with all submissions must be submitted online by and postmarked by April 15, 2019.

Evaluation of your application will be based on the following criteria:

  1. Completeness
  2. Adherence to length and time requirements
  3. Match to the following:
  • Must be a current senior in high school or current college student seeking undergraduate degree who has not yet entered their senior year in a four year program of study, or a current senior in high school or current college student seeking undergraduate degree who is accepted in a two-year community college
  • Must have achieved a minimum cumulative GPA of 2.5 on a 4.0 scale
  • Current transcripts, official and unopened from the applicant’s current educational institution must accompany this application
  • Must be attending or will attend an accredited college or university in the United States. (Incoming freshmen please include copy of Letter of Acceptance.)
  • Must provide an original letter on letterhead of your diagnosis of Chronic Tic Disorder or Tourette’s Syndrome provided by and signed by your neurologist or psychiatrist. This will be verified for authenticity.
  • Must provide three letters of character reference no longer than one page in length, front only, original, signed by the sender, from as follows:
    • One family member
    • One academic reference
    • One employment or academic reference

Please note: We have changed our policy to accept online applications only. Mailed portions are still required.

Online entry version below (still requires mailed portions.) Please note: There is an option to input information and save the document and continue at a later time. Use the “Save and Continue” button found at the end of the application if you wish to do this. You will be provided with an opportunity to have your partial application emailed to you as a link…be sure to scroll down in the page to see the entry box. You will have 30 days to complete the process once you click Save and Continue. For any questions please email info@dollars4ticscholars.org.

2019 Undergrad D4TS Application

Official 2019 online D4TS scholarship application for undergraduate college students
  • SECTION I: PERSONAL

  • Please provide breakdown of sections and related scores
  • SECTION II: FINANCIAL

    NOTE: All information is required to determine comparative need. A copy of your FAFSA (Free Application for Federal Student Aid) Student Aid Report (SAR) is required, which will include Expected Family Contribution and income information. After filling out and processing your FAFSA online, print and submit the “Student Aid Report” section via mail as explained below in Section VII: Instructions for Submittal. The SAR is a multi-page document.
  • Number of Family Members living in your household: (including yourself, parents, siblings and others)
  • Funding from other sources with amounts: State Pre-Paid Program, Other scholarships or Grants
  • SECTION III: ACCOMPLISHMENTS AND ACTIVITIES

  • Please follow the exact format of Work Experience 1 above to enter additional work experience in the above box.
  • SECTION IV: VIDEO

    Please provide a simple personal video of you telling us what you want to do after you graduate from college. What is your passion? What is your mission for your future? What will your life in the real world be like? Videos will not be judged on technical skill. However, please make sure you film in a well-lit area and check sound to be sure it is clear. Please upload to YouTube as at least an Unlisted video (Public is up to you.) If it is marked as Private, we can't see it and may not be able to contact you to update it. You have up to 3 minutes.
  • Copy and paste the link to your unlisted YouTube video.
  • SECTION V: DECLARE THYSELF

    The components of this section should be created in Microsoft Word prior to upload to avoid file loss. Copy and paste the answers into the below boxes after your Word document is complete. Use "Review/Word Count" to be sure you are following the word count guidelines.
  • Please write an essay of 300 to 500 words on what life has been like for you as a person with Tourette’s Syndrome including one particularly meaningful or memorable occasion. This may include your school experiences, social experiences, family experiences. Also include why you deserve this scholarship.
  • SECTION VI: PERMISSIONS & SIGNATURES

    a) Winning scholarship recipient essay will be included in the www.dollars4ticscholars.org website. If I choose “no” below and then am chosen as a recipient, I will be contacted by Dollars 4 Tic Scholars for permission for use.
  • b) Applicants not chosen to receive a scholarship may also allow Dollars 4 Tic Scholars to use their essay for web content. The essay is used as part of the scholarship fundraising and awareness efforts of The Kelsey B. Diamantis TS Scholarship Family Foundation. Your participation in this publication of your essay is entirely optional, and your agreement or non-agreement will in no way affect your chances for a scholarship. We would appreciate your participation and will honor your choices below. (Please check all that may apply.)
  • If yes, please upload a recent .jpg head shot photo.
    Drop files here or
    Accepted file types: jpg, png.
  • c) Winning scholarship recipient will be mentioned with submitted headshot photo in a press release issued by The Kelsey B. Diamantis TS Scholarship Family Foundation, Inc. Your submittal of this application indicates your permission and agreement for participation in the press release, which will include, at the minimum, name, age, hometown, incoming grade, major, and institution attending. Press release will be submitted to winning recipient for review prior to distribution, with a deadline for its return.
  • d) Scholarship recipients are selected by an independent Selection Committee. I understand that all decisions of the Selection Committee are final, and are determined while providing equal opportunity for all genders, ages, races, ethnicities, and geographic location.
  • e) I understand that my photo, should I be chosen as the recipient, will be used in email letters to subscribers and on the Facebook page of The Kelsey B. Diamantis TS Scholarship Family Foundation, Inc., aka Dollars 4 Tic Scholars as part of the recipient announcement.
  • f) I agree that Dollars 4 Tic Scholars may add my email address to their email list to receive update and promotional emails. I understand that I may unsubscribe at any time.
  • g) As part of helping promote the continued awareness of The Kelsey B. Diamantis TS Scholarship Family Foundation, Inc., and if I am a recipient, I am agreeing that should I be contacted by the organization with requests for campus photos, testimonials or a short video and the like, I will be responsive and willing to provide the materials requested if at all possible.
  • h) So that the organization can keep up to date on my academic and employment progress if I am a TS scholarship recipient, and so The Kelsey B. Diamantis TS Scholarship Family Foundation, Inc. can measure the success of its programs, I agree to respond annually to a survey asking me about my enrollment, graduation and employment status. I also agree to provide and update my contact information to the organization.
  • i) Thank you for applying for our scholarship. Please fill out below:
  • declare that all of the aforementioned information that I have submitted is true and accurate to the best of my ability. I agree to items a) through h) above. I am aware that my submitted materials are being reviewed confidentially by a Scholarship Selection Committee.
  • SECTION VII: INSTRUCTIONS FOR SUBMITTAL

    Please mail in a large envelope to:
  • The Kelsey B. Diamantis TS Scholarship Family Foundation, Inc., 21801 Little Bear Lane, Boca Raton, FL 33428
  • For questions or issues uploading your headshot, please email info@dollars4ticscholars.org. Please do not bind your hardcopy documents into a booklet. This creates an issue for our reviewers. Paperclips are preferred over staples. Please "Like" our Facebook page at Dollars 4 Tic Scholars to keep up with scholarship announcements. Thank you for your application. Best of luck!
  • This field is for validation purposes and should be left unchanged.

Thank you for your application. Best of luck!