Vital Impact 2016 Application for Scholarship Funds


You must complete the entire application. Unless otherwise indicated, the requested information is required. If a question or section does not apply to you, mark it “NA” for “not applicable.” Some supporting documentation will be needed to be submitted separately; please see instructions for each section. Please be sure to have access to a printer when completing forms online as you will need to print pages when they are completed for submission via U.S mail.

If your application is incomplete, it will not be considered.

Eligible applicants must demonstrate scholastic ability, leadership skills, and new career goals. To be eligible you must be:

  • A woman at least 35 years of age
  • A U.S. citizen
  • A resident of Massachusetts for at least the 12 months immediately prior to the application deadline
  • Enrolled in or attending an accredited educational institution of higher learning or vocational training located in Massachusetts; and
  • Have new career goals

The application deadline is June 15, 2016 for the fall semester. Scholarship funds awarded will be applied to the recipient’s account at her school.

Your application and supporting documents must be postmarked no later than June 15, 2016 and mailed to:
Vital Impact
P.O. Box 192
Accord, MA 02018-0192

Vital Impact Checklist

For your convenience while filling out the application, download the checklist here.

You can download our privacy policy here.

Your complete application must include each of the following documents:

  • A completed application. Download Here
  • Your most recent transcript with authorized signature and official seal showing your GPA – To be mailed separately
  • Proof of Massachusetts residency – photocopy of a Massachusetts issued driver’s license OR a Massachusetts issued photo identification card
  • Proof of United States citizenship – photocopy of United States birth certificate, United States passport OR United States INS naturalization card
  • Proof of Age – photocopy of birth certificate, passport or other government issued document.
  • Your signature and date on the Declaration of Accuracy. Download Here
  • Your signature and date on the Release of Information for Publicity Purposes form. Download Here
  • Voluntary Statistical Data Form. Download Here
  • The Statement of Acceptance and Schedule of Fees with authorized signature. Download HereTo be mailed separately
  • Two recommendations from non-relatives using this Vital Impact form. Download Here To be mailed separately by June 15, 2016 to:
    Vital Impact
    P.O. Box 192
    Accord, MA 02018-0192

The inclusion of the following documents is optional:

Resumes, copies of certificates, awards, etc.