ACPD-Gerry Bertier Scholarship Application

Applicant Information

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, 2024.

Please use this as a checklist, checking each box to ensure the application is complete. *This question is required.

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

Name of Applicant: *This question is required.

Address: (house number, street, city, state, zip) *This question is required.

Email Address: *This question is required. This question requires a valid email address.

Telephone Number: *This question is required.

Date of Birth: *This question is required.

calendar

Date of High School Graduation: *This question is required.

calendar

Describe your disability *This question is required.

Identify specific school/program in which you intend to enroll *This question is required.

List and briefly describe awards and/or extracurricular activities *This question is required.

Other sources of financial aid for which you have applied or are receiving *This question is required.

PERSONAL STATEMENT

Please explain how you plan to use your education to help make the world a better place. *This question is required.

REFERENCES : Please provide three references. At least one is required. References may be from any of the following: teacher, counselor, mentor, or work supervisor. *This question is required.

Space Cell	Name of Reference and Relationship	Telephone Number	Email Address
Reference 1	Name of Reference and Relationship	Telephone Number	Email Address
Reference 2	Name of Reference and Relationship	Telephone Number	Email Address
Reference 3	Name of Reference and Relationship	Telephone Number	Email Address

ACKNOWLEDGEMENT

*This question is required.

To the best of my knowledge all of the information in this application is accurate and correct. I understand that if selected for a scholarship, my name and photograph may be used for media coverage.
Scholarship funds will only be distributed directly to, and in the name of, the specific institution named in the above application upon receipt of the invoice.

Name of Applicant: *This question is required.

Date: *This question is required.

calendar

Gerry Bertier Scholarship Award Guidelines

The applicant must be:
1. A person with a physical, sensory, or cognitive disability who is pursuing post-secondary education and
2. A resident of the City of Alexandria or a student at a school located in the City of Alexandria
The award will be:
1. Up to $1,000 per recipient per year.
2. Available for tuition, room, board, supplies, or fees.
3. Payable to the post-secondary institution.
4. Usable over the length of the recipient's post-secondary educational career.
5. Non-transferable
6. 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:
1. Attend the ACPD Awards ceremony to receive the scholarship or shall be represented at the Awards Ceremony by an alternate.
2. 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:
1. Academic and extra curricular achievement.
2. Plans to give back to the community.
3. References.
4. Financial need.
5. Previous Bertier Scholarship awards.

For reasonable disability accommodation, contact namoode.khan@alexandriava.gov or call 703.746.3140, Virginia Relay 711.