SCHOLARSHIP APPLICATION FORM
To apply for a scholarship,
complete this application form and mail completed application and attachments
to:
Tammy Winn, Scholarship
Committee Chairperson
Minot
AFB, ND 58704
This form must be received by
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 2009 (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.
CRITERIA: All scholarships are awarded on the basis of
academic excellence, financial need, and service to the community.
Applicants should be a full-time
student with a GPA of 2.5 or better on a 4 point scale.
An applicant must have a
visual impairment that cannot be corrected with prescription glasses.
Applicants must be a resident
of
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. Each applicant will be considered for all
scholarships available, which are: a $1000 scholarship and two $500
scholarships (a total of three scholarships).
Please provide all the applicable information requested and attach to
the application.
For more information contact Tammy
Winn at (701) 727-9211 or roytammy@srt.com .
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.