Gregory Kelly Memorial Fund Scholarship Application
Gregory Kelly was a true leader in advocating for people living with and otherwise affected by HIV and AIDS. To honor his memory, the Coalition on AIDS in Passaic County, Inc. (a.k.a. CAPCO Resource Center) has established a memorial fund in his honor. This fund will award one scholarship, annually, to an emerging advocate for people living with and otherwise affected by HIV and AIDS.

Applications will be accepted through 11:59 PM EST on February 15, 2021. A recipient will be chosen and notified no later than April 7, 2021.

To help determine the best candidate for this annual scholarship, the following eligibility criteria have been created:

+ Recipient must be living with HIV/AIDS or otherwise directly impacted by HIV (i.e. being the child of or being the spouse of someone living with HIV)
+ Recipient must be residing in Bergen or Passaic Counties, NJ at the time of application
+ Special attention will be paid to applicants residing in Paterson, NJ
+ Special attention will be paid to applicants who have been Bergen-Passaic residents for over five years
+ Recipient must show a demonstrated commitment to advocating for the needs of people living with HIV and AIDS; examples of such commitment include:
- Serving on the board of an AIDS Service Organization (ASO) or HIV planning council/group
- Volunteering for an ASO or HIV planning council/group
- Providing educational presentations to community members on HIV
- Providing Designated Effective Behavioral Interventions (EBIs) to community members, including but not limited to CLEAR, Healthy Relationships, Safety Counts, RESPECT, Voices/Voces, Many Men Many Voices, and more
- Providing certified HIV Counseling and Testing to community members
- Leading or volunteering for other HIV-focused causes through social media, in-person actions, or more
Etc.
+ Recipient must demonstrate financial need
+ Individuals of all documentation status are eligible to apply, including
- Legal citizens
- Permanent residents
- Undocumented individuals
+ Individuals from marginalized communities are encouraged to apply, including:
- Black, Indigenous, and People of Color (BIPOC) individuals
- Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals
- Disabled individuals
+ Current CAPCO Board Members and Employees are excluded from applying:
- You may only be considered if you have not been affiliated for more than two years

If you believe you are a good fit for the Gregory Kelly Memorial Fund Scholarship and would like to apply, please complete the application below.
What is your name? *
What is your email address and/or phone number (for contact purposes, should you be awarded the scholarship)? *
What is your date of birth? *
MM
/
DD
/
YYYY
What is your gender? *
Do you identify as transgender? *
What is your ethnicity? *
What is your race? *
What other identities do you hold that you would like us to know about?
What is your current address? *
How long have you been living at your current address? *
How long have you resided in Bergen and/or Passaic Counties? *
How has HIV impacted your life? (Please specify if you are living with HIV or are close to someone who is.) (100 words or less.) *
How have you been involved with advocacy for people living with HIV in your community? (Please include relevant experience with HIV planning councils and HIV-service nonprofits, if applicable.) (100 words or less.) *
How would receiving the Gregory Kelly Memorial Fund Scholarship make a difference in your life? Be as specific as possible. Feel free to describe your financial need in this space. (100 words or less.) *
In one to three sentences, how would you continue Gregory’s legacy of advocating for those living with HIV, should you be awarded this scholarship? *
Should you be awarded the Gregory Kelly Memorial Fund Scholarship, do you agree to have your name, picture, and/or HIV status publicized by CAPCO Resource Center? (An answer of “no” does not exclude you from applying) *
Please include your resume or biography of experiences, if applicable. You may either copy and paste your resume or biography of experiences into the following text box, OR email these documents to the CAPCO Resource Center Board of Trustees at capcoresourceboard@gmail.com. (A resume or biography of experiences is NOT a requirement to apply for this scholarship.)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy