Scholarship Application

Donna Pomerantz

President

 

CALIFORNIA COUNCIL OF THE BLIND

EXECUTIVE OFFICE

1303 J Street, Suite 400

Sacramento, CA 95814-2900

FAX 916-441-2188

E-Mail: ccotb@ccbnet.org 

Webpage: www.ccbnet.org

 

                    

 

 

 

 

CALIFORNIA COUNCIL OF THE BLIND

 

1303 “J” Street, Suite 400

Sacramento, CA 95814-2900

 

800-221-6359

916-441-2100

 

SCHOLARSHIP AWARDS APPLICATION

FOR SCHOOL YEAR 2014 - 2015

 

The California Council of the Blind gives a number of awards to the most deserving student applicants who are legally blind residents of California. Awards are made to students who will enter or continue undergraduate or graduate studies at an accredited college, university, or vocational school. Applicants must be enrolled on a full-time basis. It is not required that the institution attended be located in California. These awards are granted in two parts (half in the Fall and half in the Spring) upon receipt of proof of enrollment. Awards will be granted on the basis of academic performance and other factors. Your application must be typed or it will be automatically rejected. If you have previously applied, you must submit an entirely new application, including supporting documentation. Your application may be denied if it is incomplete. If a requested item is not applicable, please provide a brief explanation.
List of items required for the application process:
1. A completed (typed or word processed) application form
2. Official transcripts (with institution’s seal)
3. Doctor’s verification of legal blindness
4. Letter(s) of recommendation (Optional)
*************
Your application will be rejected if you fail to include a Doctor’s statement or a statement from a qualified professional, such as a 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 12 semester/8 quarter units for each term of the entire academic year or 9 semester/6 quarter units each term for graduate students. If you believe that you have extenuating circumstances, such as additional disability or job requirements, that prevent you from meeting this requirement, please provide a complete explanation of your situation.

 

If your award is approved, you must submit, for each half of the award, written proof of enrollment. This proof of enrollment must be signed by the Registrar on school letterhead and must include a complete list of 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: _______________________

 

Applicant’s full name:_____________________age____gender_______

 

 

 

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: ______________________________

 

Freshmen applicants please provide:

High School attended:_________________________

                                    name               city                 state

 

List previous colleges attended: (years attended and total units completed) (Please specify quarter or semester units)

 

college name_______________ 

_________________­_From_____to_____Units_____

                              Date     Date

_________________­_From_____to_____Units_____

college name_______________ 

                                                 Date     Date

 

_________________­_From_____to_____Units_____

college name_______________ 

                                                 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 this 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 typewritten statement (not more than 200 words and double spaced) giving your purpose in undertaking college work and your vocational goals. (For previous applicants, your prior statement is not acceptable.)

You may also mention your interests and avocations.

 

If you are a member of the California Council of the Blind, we would appreciate a current letter of recommendation from the President of your chapter or affiliate. If you are not a member but you know a member, we would appreciate a current 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 May 30, 2014 at 5 pm.  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 14, 2014.  

 

 

 

 

 

We will attempt to arrange a telephone interview. Accurate summer telephone numbers and addresses are vital to the processing of this application.

                         (revision 03/2/2014)