Applicant´s State


Applicant´s Zip Code


Applicant´s Phone Number


Applicant´s Email Address


Please Specify Your Disability(s)

Please respond to the following questions:

Each applicant must submit two (2) letters of reference or support from individuals familiar with the applicant´s work that positively impacts the disability community. The letters should be uploaded via this website.

Reference #1 - Name

Reference #1 - Email


Reference #1 - Letter of Reference


Reference #2 - Name


Reference #2 - Email


Reference #2 - Letter of Reference

If you prefer to complete the application in MS Word format, click here to download the application

Semi-finalists will be contacted for phone interviews.

By submitting an application, you are confirming the following:

• You are between the ages of 14 and 26
• You are a person with a disability
• You currently reside in the Washington, DC metropolitan area
• You are not an employee of the HSC Health Care System or a member or family member of it´s Board of Directors
• You are able to attend the ADA/YTI Briefing Reception on June 3, 2010 (at a location in Northwest DC)
• You will provide The HSC Foundation (HSCF) with an interim progress report (by December 1, 2010), and a final report (by May 31, 2011) detailing the use of the $7,000 towards the project/activity stated in the application
• You will make every effort to promote the Advocates in Disability Award (ADA) program in your advocacy work, including your participation in various HSCF activities and / or activities arranged by HSCF
• You are providing permission to the HSC Foundation to use photos and materials related to you and your ADA project/activity for marketing/PR, education, and promotional purposes