Appendix M: Personal Care Assistant Scholarship

Scholarship for DO-IT Scholar Personal Care Assistant Salary

Families for whom the cost of a personal care assistant salary would impede a Scholar from attending the Summer Study program may apply for a scholarship of up to $350 per week. DO-IT Scholars and their parents/guardians are responsible for hiring adult (over the age of eighteen years) personal care assistants and paying their salaries. DO-IT pays for room and board for personal care assistants who work for Scholars during the Summer Study program. Parents of Scholars are not eligible to be paid as personal care assistants through this scholarship. A parent/guardian or adult Scholar must complete and return the form below to apply for need-based scholarship for the salary of a personal care assistant.

Sheryl Burgstahler
Director, DO-IT (Disabilities, Opportunities, Internetworking, Technology)
Box 355670, University of Washington
Seattle, Washington 98195-5670

DO-IT Application
Scholarship for Personal Care Assistant

Name of DO-IT Scholar:_____________________ Telephone: ________________________

Name, Social Security Number, and Resident Status of person responsible for covering cost of personal care assistance (parent/guardian or adult Scholar who will use the funds to pay the salary of the personal care assistant)—The check will be made payable to this person:

Name: ____________________________ Social Security Number: __________________
Resident Status (choose one): U.S. Citizen/Nonresident Alien/Resident Alien

I request that $___________ total (up to $350/week) be provided for the salary of a personal care assistant during the DO-IT Summer Study program. I have not accepted and do not plan to accept other funding for this portion of personal care assistant costs, and I will notify DO-IT immediately if other funding becomes available.

I intend to pay ______________________(name of personal care assistant) for personal care assistance during the DO-IT Summer Study program. I understand that the check will be mailed to me after the conclusion of the Summer Study program and it is my responsibility to use these funds exclusively to pay the salary of the assistant for the Scholar named above.

Signature of DO-IT Scholar:_________________________ Date:__________________

Signature of Parent/Guardian, if the DO-IT Scholar is under the age of eighteen: __________________________________________________ Date__________________