NORTH DAKOTA ASSOCIATION OF THE BLIND
EMMA SKOGEN SCHOLARSHIP APPLICATION
To apply for the Emma Skogen scholarship, send completed application and attachments, no later than March 15, 2012, to:
North Dakota Association of the Blind
Tracy Wicken, Scholarship Committee Chairperson
733 Dawn Circle
Grand Forks, ND 58203
Name: _______________________________________________________
Address:______________________________________________________
_____________________________________________________________
Phone Number (day): ___________________________________________
Phone Number (evening): ________________________________________
E-mail: _______________________________________________________
Gender: Male__________ Female__________
Date of Birth: _________________________
Address to which correspondence should be sent (if different from above):
___________________________________________________
___________________________________________________
Phone Number (day): ___________________________________________
Phone Number (evening): ________________________________________
The criteria by which the candidates are evaluated are:
1) Financial need (Describe and give as much detail as possible when you indicate cost of program with your ability to pay.)
2) Statement of education and career goals
3) Involvement in school and community activities
4) Other, e.g., work experience.
Please complete the following information requested (attach extra sheet of paper, if necessary) and attach:
a) An official copy of your latest grade transcript,
b) A letter of recommendation (written by teacher, youth leader) describing your character and abilities.
My cumulative grade point average:_______________
High School Grade Point Average: _______________
College Grade Point Average: _______________
If you are on a scale other than 4.0, please indicate: ____________________
School Which You Plan To Attend In Fall 2012:
Name: _______________________________________________________
Address: ______________________________________________________
Financial need must be stated:
Cost of Program: $________________
Ability to Pay: $________________
Gap to be made up: $________________
Comments (Describe and give as much detail as possible): __________________________________________________________________________________________________________________________
I plan to study:_________________________________________________ _____________________________________________________________
My long-term career goals are:__________________________ __________________________________________________________________________________________________________________________
I am currently working: _______ Yes _______ No
I am planning to work while pursuing my studies: _______ Yes _______ No
Comments:
__________________________________________________________________________________________________________________________
Signature: ______________________________________Date:__________