CK Life Surgery Scholarship Fund

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CK Life Surgery Scholarship Fund

CK Life will be accepting applications until December 31st, 2012 3:00AM EST. This is the second cycle of surgery scholarships offered by CK Life.
COMPLETE Applications will be accepted by email only. Send e-mail applications to: Scholarshipfund@cklife.org. Applications must be in DOC or PDF Format. Late applications will not be accepted.
Applications will be considered temporarily complete if all parts are complete but professional letter is pending. A notification of complete application will be given upon receipt of letter. **ANYONE who is a CK LIFE CLINIC PATIENT or Friday H.O.M.E GROUP MEMBER does NOT have to include professional letter in application. For this section of application just note that you are a CK LIFE clinic patient or H.O.M.E. Group Member.
CK Life will accept Provider letters by mail if provider unwilling to give letter directly to applicant to email with application. If this is the case please state it in the application under Professional letter section.
Mailed letters must be postmarked by December 31st, 2012 to be accepted.
Mail: Attn: CK Life Scholarship Fund
P.O. Box 6060
Bronx, NY 10451

Application Criteria

I. Cover Page

Name (Both Legal and Preferred if different)
Date of Birth (Applicants must be age 18 By January 1st, 2013 to receive scholarship)
Contact Info (Email and/or Telephone)
Must State which ONE Surgery* they are asking for assistance accessing
*ONE surgery must be selected (hysterectomy With GRS will count as one surgery. Multiple FFS which are performed by the same surgeon in one operation will count as ONE surgery.
Name of Surgeon(s) you prefer to go to. An alternate surgeon may be named as well if still deciding

II. Personal Statement

Write a personal statement of no more than 1000
Detail what efforts you have made to fund raise or save towards your surgery
Please include in this statement who will care for you and provide support post surgery
Include how having surgery will impact your life

III. Professional Letter

One letter from a Medical OR Mental Health Provider.
Acceptable Providers: MDs, DOs, Nurse Practitioners, Psychiatrists, Social Workers, therapists, licensed/Certified Counselors (if any questions about your provider email us)
Letter must state how long you have been in transition and what steps you have taken/completed in yoru transition process.
Note: CK Life understands there is no one way to transition but applicants must meet WPATH standards of care with regards to being eligible for scholarship approval. For a list of standards check out the WPATH.

IV. Personal Reference

From a family member, friend/associate or co-worker stating why they think we should pick you for a surgery scholarship
Contact information should be included
Must be a maximum of 500 words.

V. Financial Statement

State Annual income and source of income
Annual Expenses
Amount Saved towards surgery, if any, with a break down (I.e. $500 for Travel saved, $1,000 towards surgery saved)
Amount needed toward surgery
State whether or not you have insurance. If you have insurance state what kind.

***Due to non profit status all applicants must be a US Citizen or Legal Resident
All Applicants will be given an application number. You can request an application number now. This number must be included in all application materials to help keep track of application. IF you forget or misplace your application number contact us. IF you applied for the previous application cycle let us know and you will get a SIMILAR application number.
***Any Statements in the application found to be knowingly incorrect/untrue will eliminate applicant from current scholarship cycle and any future scholarship cycles.
Selection of scholarship recipients will be done by a CK Life affiliate with name being omitted from the application to keep the selection unbiased. Applicants must meet WPATH standards to be granted a scholarship. All applicants will be notified of a final decision on their application. Date of Notifications TBA. (check back frequently for updates)
If you are selected for funding all Money will be paid directly to the Surgeon or Hospital/surgical facility.
Any awarded funds MUST be used within 3 months or 6 months (for Genital surgeries) of time they are awarded. If there are extenuating circumstances (such as surgeon has a long waiting list) then that time frame may be extended based on the circumstances. If the funds are not used in an appropriate amount of time then the funds will go back into the pool of money towards the next scholarship Cycle.