ACPD Gerry Bertier Scholarship Application IMPORTANT - You must be a City of Alexandria resident or a student at a school located in the City of Alexandria to apply. All Gerry Bertier Scholarship applications must be received by April 30, 2025. Question Title * Please use this as a checklist, checking each box to ensure the application is complete. All areas of the application must be completed prior to submission. Personal statement on how you plan to use your education must be explained clearly. You must include the names of three references and their contact information. Questions about the scholarship and completed applications should be directed to ACPD@alexandriava.gov APPLICANT INFORMATION Question Title * Name of Applicant: Question Title * Address (house number, street, city, state, zip): Question Title * Email Address: Question Title * Telephone Number: Question Title * Date of Birth: Date / Time Date Question Title * Date of High School Graduation: Date / Time Date Question Title * Describe your disability: Question Title * Identify specific school/program in which you intend to enroll: Question Title * List and briefly describe awards and/or extracurricular activities: Question Title * Other sources of financial aid for which you have applied or are receiving: PERSONAL STATEMENT Question Title * Please explain how you plan to use your education to help make the world a better place: REFERENCES: Please provide three references. At least one is required. References may be from any of the following: teacher, counselor, mentor, or work supervisor. Reference 1 Question Title * Name of Ref. & Relationship Question Title * Telephone Number Question Title * Email Address Reference 2 Question Title * Name of Ref. & Relationship Question Title * Telephone Number Question Title * Email Address Reference 3 Question Title * Name of Ref. & Relationship Question Title * Telephone Number Question Title * Email Address Question Title * ACKNOWLEDGEMENT To the best of my knowledge all of the information in the application is accurate and correct. I understand that selected for a scholarship. my name and photograph may be used for media coverage. Question Title * Name of Applicant: Question Title * Date of Application: Date / Time Date Gerry Bertier Scholarship Award Guidelines The applicant must be: A person with a physical, sensory, or cognitive disability who is pursuing post-secondary education and A resident of the City of Alexandria or a student at a school located in the City of Alexandria The award will be: Up to $1,000 per recipient per year Available for tuition, room, board, supplies, or fees Payable to the post-secondary institution Usable over the length of the recipient's post-secondary educational career Non-transferable Forfeited to the extent that the funds are not used prior to completion or termination of the recipient's post-secondary educational career The recipient shall: Attend the ACPD Awards ceremony to receive the scholarship or shall be represented at the Awards Ceremony by an alternate Provide feedback to the ACPD on the process for applying for the scholarship and the collection of the proceeds of the award. Each application will be reviewed for the following criteria:Academic and extra curricular achievement. Plans to give back to the community References Financial need Previous Bertier Scholarship awards For reasonable disability accommodation, contact miladis.martinez@alexandriava.gov or call 703.746.3140, Virginia Relay 711. Send me a copy of my responses via email DONE