Drive to Serve Scholarship
presented by the American Red Cross Central Ohio Blood Services Region
Application Form
Complete all form fields. Submissions must be typed or printed neatly. Illegible applications will not be considered.
If printing by hand, please see Page 3 for more information. Application deadline is May 29, 2009.
School: Ohio University
Main campus
Applicant name:
Other:
Birth date:
Last
First
Major:
MI
Rank:
M/D/YYYY
Student ID:
Permanent Address:
Street
City
State
ZIP+4
City
State
ZIP+4
Campus/Temporary Address:
Street
Phone:
E-mail:
American Red Cross Blood Services
Are you a blood donor or blood drive volunteer? List current and/or past activities and describe involvement.
Have you served as coordinator of a blood drive? List dates, sponsor group name, and location for each.
Other Red Cross lines of service
Have you volunteered with the Red Cross in other areas? List any current and/or past projects with Red Cross
chapters, and describe your involvement and any leadership roles in detail.
Drive to Serve Scholarship application, Page 2 of 3
Other volunteer service
List roles, dates of service and describe entailed activities and responsibilities.
Current volunteer service
Participant roles:
Leadership roles:
Past volunteer service
Participant roles:
Leadership roles:
/
I affirm that the information provided in this application
is truthful and accurate. (Initial and date at left.)
Drive to Serve Scholarship application, Page 3 of 3
Terms & conditions
2009 Drive to Serve Scholarship at Ohio State University
offered by the American Red Cross Central Ohio Blood Services Region

Applications must be postmarked or submitted electronically no later than May 15, 2009, to be
considered. Two winners, each of whom will receive a $250 scholarship, will be selected and
notified by May 31, 2009.

The recipient of this scholarship must participate in at least one Red Cross blood drive, as either a
blood donor, or as a volunteer in some other capacity.

Applicants must be enrolled in a participating post-secondary educational institution at the time of
submission, and must continue to attend an accredited post-secondary school during fall 2009. Both
undergraduate and graduate students are eligible.

If the individual selected to receive the scholarship is awarded another scholarship covering all postsecondary school expenses, or if the winner elects not to enroll in a post-secondary educational
institution in fall 2009, an alternate winner will be selected.

The Food and Drug Administration (FDA) strictly regulates agencies involved in the collection,
testing and distribution of blood products. The FDA has determined scholarship programs offered by
blood banks must comply with certain guidelines the agency has established regarding voluntary
blood donation. These regulations require that any funds awarded as a scholarship can only be
used for tuition/fees assessed by the education institution. The scholarship funds must be
transferred directly from the American Red Cross to the post-secondary school the student will
attend during fall 2009.

The scholarship winner may be recognized by a representative of the Red Cross during a school
end-of-year awards event as the recipient and school determine.

The winner shall be chosen based on community service reported in the application, without
discrimination regarding an individual’s ethnicity, religion, or gender.

Blood donors must be at least 17 years old, weigh a minimum 110 pounds, be in good health and
present a donor card or positive ID upon donation.
/
I agree to the terms and conditions outlined above.
(Initial and date at left.)
Submission
Electronic submission is preferred, and applications can be e-mailed as an attachment to [email protected].
Please reference "Post-Secondary Scholarship Program" in the subject of the e-mail message.
If you are completing the form by hand, you can remove gray fields. To do so, open the Forms Toolbar, then click
the Form Field Shading button, which looks like an "a" with a shaded box around it.
Hard copies of applications can be mailed to:
American Red Cross
Central Ohio Blood Services Region
ATTN: Post-secondary Scholarship Program
995 East Broad Street
Columbus, OH 43205-1339
04/09AP341