NORTH DAKOTA ASSOCIATION OF THE BLIND

SCHOLARSHIP APPLICATION

To apply for a scholarship, complete this application form and mail completed application and attachments to:

North Dakota Association of the Blind

Tracy Wicken, Scholarship Committee Chairperson

733 Dawn Circle

Grand Forks, ND 58203

This form must be received by March 15, 2012

Name: _______________________________________________________

Address:________________________ ______________________________

Phone Number (day): ___________________________________________

Phone Number (evening): ________________________________________

E-mail: _______________________________________________________

Gender: Male__________ Female__________

Date of Birth: _________________________

Living On Your Own: Yes__________ No__________

Your Annual Income: ___________________

List Exceptional Living Expenses for Household (e.g. medical, etc.):

__________________________________________________________________________________________________________________________

*An applicant is not eliminated on the basis of economic need alone.

School in Which You Are Presently Enrolled

Name: _______________________________________________________

Address: ______________________________________________________

Class Standing (e.g. Freshman, Sophomore, etc.): _____________________

Cumulative grade point at this institution:__________

School Which You Plan To Attend In Fall 2012 (if different from above):

Name: _______________________________________________________

Address: _____________________________________________________

Major: _______________________________________________________

Degree/Certificate Sought (e.g. BA, BS, MA, MS, PhD): _______________

Date Degree Expected (month/year): _______________________________

List all post-secondary institutions attended with highest class standing attained and cumulative grade point average:

__________________________________________________________________________________________________________________________

Awards and Honors (attach list if necessary):

__________________________________________________________________________________________________________________________

Community Service (attach list if necessary):

__________________________________________________________________________________________________________________________

Vocational Goal:_______________________________________________

__________________________________________________________________________________________________________________________

Cause of eye condition, present condition, and prognosis: _______________

__________________________________________________________________________________________________________________________

ATTACH THE FOLLOWING DOCUMENTS TO COMPLETED APPLICATION:

1. How will the scholarship help you?

What are your goals and aspirations?

What have you done to deal with situations involving your visual impairment?

What are your vocational interests (pastime interests and hobbies)?

Include any additional information you wish.

2. Include two letters of recommendation.

3. Provide current official transcript from institution now attending and transcripts from other post-secondary institutions attended.

4. Provide a Financial Aid Award Letter for verification of financial status.

NORTH DAKOTA ASSOCIATION OF THE BLIND

SCHOLARSHIP PROGRAM

CRITERIA: All scholarships are awarded on the basis of academic excellence, financial need, and service to the community.

Applicants for the $1,000 scholarship should be a full-time student with a GPA of 2.5 or better on a 4 point scale.

Applicants for the $500 scholarships may be a part-time student.

An applicant must have a visual impairment that cannot be corrected with prescription glasses.

Applicants must be a resident of North Dakota.

Recipients of NDAB Scholarships need not be members of the North Dakota Association of the Blind

DEADLINE: Applications for the NDAB scholarships must be received by March 15th of the year in which the scholarship is to be awarded.

APPLICATION: Complete and return this application. Multiple applications are unnecessary. Full-time students who apply will be considered for all scholarships available, which are: a $1000 scholarship and two $500 scholarships (a total of three scholarships). Part-time students who apply will be considered for the two $500 scholarships. Please provide all the applicable information requested and attach to the application.

For more information contact Tracy Wicken

trwicken@nd.gov .

REAPPLICATION: Applicants are encouraged to reapply. Even if previously submitted, current applications must be submitted to be considered for current scholarships. Previous recipients of this scholarship may reapply annually.

WINNERS: The NDAB Executive Board will review the final selection of applicants, screened by the Scholarship Committee and allocate the scholarships to the final recipients.

Scholarship recipients will be notified of their selection by May 15th and will be announced at the Annual North Dakota Association of the Blind Convention in June and awarded upon proof of full time enrollment in a post- secondary institution. Notification will be made to all applicants as to the outcome of the Board's decision.