CALIFORNIA COUNCIL OF THE BLIND
1510 “J” Street, Suite 125 Sacramento, CA 95814
800-221-6359 916-441-2100
SCHOLARSHIP AWARDS APPLICATION FOR SCHOOL YEAR 2011 – 2012
The California Council of the Blind gives a number of awards to the most deserving blind student applicants who are residents of California and who will enter or continue studies at an accredited college or university in either undergraduate or graduate status. Persons attending vocational schools are also eligible. It is not necessary to be attending a college or university in California. These awards are granted in two parts (½ each term) upon receipt of proof of enrollment for each term. Awards will be granted on the basis of academic scholarship and other factors. THIS APPLICATION MUST BE TYPED OR IT WILL BE AUTOMATICALLY REJECTED. Even if you have previously applied, you must submit an entirely new application, including supporting documentation. Every year we deny applications solely because they are incomplete. If an item is not applicable, please provide a brief explanation. Do not fail to include a Doctor’s statement or a statement from a qualified professional, such as a Social Worker or Rehabilitation Counselor, certifying that you are legally blind.
To qualify to receive a scholarship award, you must be a full time student registered for at least 9 units for each term of the entire academic year. If you believe that you have extenuating circumstances, such as additional disability or job requirements, that do not enable you to meet this requirement, please provide a complete explanation of your circumstances.
Once an award has been approved, when the student applies for his or her award each term, he or she must submit written proof of their enrollment, signed by the Registrar on school letterhead, including a complete list of the classes and total units to be taken.
When beginning or continuing work on a thesis or dissertation, a letter from the Dean, or Department head stating that the student is working on their thesis or dissertation, must be provided. This must be done at the beginning of each term. No monies will be allocated if proof of enrollment or continuing thesis or dissertation studies are not provided.
You must be a permanent California resident to apply.
Application date: _______________________ Page 2 of 6
Applicant’s full name:_____________________age____sex_______
Are you legally blind: yes___no___ A doctor’s or qualified professional’s verification statement is required.
Applications will not be processed without this information.
Permanent California residence address: _______________________________________ street city zip telephone
Summer address: (if different) __________________________________________ street city zip telephone
School address: (if different) __________________________________________ street city zip telephone
E-mail address: ______________________________
High School attended:_________________________ name city state
List previous colleges attended: (years attended and total units completed)
__________________From_____to_____Units_____ Page 3 of 6 Date Date __________________From_____to_____Units_____ Date Date
__________________From_____to_____Units_____ Date Date
College now attending:________________________ name city state
College you will attend this summer:______________
Total number of units completed:______
Cumulative all college grade point average:_______
Total number of units carried this term:_______
Total number of units you will carry next Fall:_______ (If your school measures course work in hours, please provide the total units you will receive.)
State your Subject Major:______________________
Are you a client of the California Department of Rehabilitation? YES __ NO __ If yes, please provide the name of your Rehabilitation Counselor. Your answer will not effect the validity of your application. ____________________________ PROVIDE A STATEMENT (NOT MORE THAN 200 WORDS) GIVING YOUR PURPOSE IN UNDERTAKING COLLEGE WORK AND YOUR VOCATIONAL GOALS. (FOR PREVIOUS APPLICANTS, YOUR PRIOR STATEMENT IS NOT ACCEPTABLE.) Page 4 of 6 YOU MAY ALSO MENTION YOUR INTERESTS AND AVOCATIONS:
IF YOU ARE A MEMBER OF THE CALIFORNIA COUNCIL OF THE BLIND, WE WOULD APPRECIATE A LETTER OF RECOMMENDATION FROM THE PRESIDENT OF YOUR CHAPTER. IF YOU ARE NOT A MEMBER BUT YOU KNOW A MEMBER, WE WOULD APPRECIATE A LETTER OF RECOMMENDATION FROM THAT PERSON. YOU MAY ALSO SEND LETTERS FROM TEACHERS OR OTHERS. EVEN IF YOU HAVE APPLIED PREVIOUSLY, PLEASE PROVIDE UPDATES AS TYPEWRITTEN INFORMATION.
(___) Check this box if you do not wish us to provide your contact information to the local chapter president of the California Council of the Blind.
IN ORDER TO PROCESS YOUR APPLICATION, THIS APPLICATION, TRANSCRIPTS AND RECORDS MUST BE SUBMITTED TO THE CALIFORNIA COUNCIL OF THE BLIND OFFICE BY JUNE 15, 2011. YOU MAY SUBMIT THE APPLICATION VIA ELECTRONIC FORMAT, BUT ALL SUPPORTING DOCUMENTATION MUST BE SUBMITTED IN HARD COPY. HOWEVER, IF TRANSCRIPTS ARE NOT AVAILABLE AT THAT TIME, YOU MAY SUBMIT THEM BY NO LATER THAN JULY 15, 2011.
Page 5 of 6
WE WILL ATTEMPT TO ARRANGE A TELEPHONE INTERVIEW. ACCURATE SUMMER TELEPHONE NUMBERS AND ADDRESSES ARE VITAL TO THE PROCESSING OF THIS APPLICATION. Page 6 of 6 (revision 02/14/2011) |