Annual AzCB Scholarship Information
Annual AzCB Scholarship Information
Please read instructions before proceeding. Complete the scholarship application and submit it in hard copy along with all documentation as a paper packet.
Send all materials to:
Arizona Council of the Blind Scholarship Program
Attn: Barbara McDonald
1727 West Osborn Road
Phoenix, AZ 85015-5828
The completed application and supporting documents must be marked no later than March 15, 2009. Online applications must be submitted by 11:59 PM (CST) March 15, 2009.
The hard copy application and documents MUST BE Typewritten. Handwritten applications WILL NOT be accepted.
Include the following with your completed application:
Autobiographical sketch: No more than two (2) pages containing information about you. Tell us about your personal goals, strengths, weaknesses, hobbies, honors, achievements, etc. Be sure to list the field or courses of study you are pursuing and explain why you have chosen it.
Certification of legal blindness from an ophthalmologist, optometrist, physician, agency executive serving the blind or other competent authority.
Certified transcripts from the school you are currently attending. Entering freshmen and sophomores, please include high school transcripts; graduate students, please include undergraduate transcripts. Unless extenuating circumstances exist, a 3.3 cumulative grade point average is required.
A recommendation letter from a current or recent instructor.
Proof of acceptance from a post-secondary school. Entering and transferring students must submit a notice or letter from the admissions office certifying acceptance or consideration for admission. Students continuing at the same school attended during 2008-2009 do not need to submit this document. If acceptance letter has not been received by due date of application, please submit application noting that letter to follow upon receipt.
Applications will be considered complete only upon receipt of supporting documents.
Please note: in some instances, the Internal Revenue Service may consider scholarship awards taxable income.
ARIZONA COUNCIL OF THE BLIND
2009 SCHOLARSHIP APPLICATION
2009 Scholarship Packet Checklist:
Completed application
Autobiographical Sketch
Proof of Legal Blindness
Letter of Recommendation
Official Transcript
Letter of Acceptance
Must be an Arizona Resident
I. PERSONAL DATA
* REQUIRED FIELD. Name:
Address:
City:
State:
Zip Code:
Telephone Number: * REQUIRED FIELD. Day:
Evening:
Cell:
* REQUIRED FIELD. E-mail Address:
Permanent and/or legal address and telephone number (if different from above):
Address
City:
State:
Zip Code:
Phone number: Male/Female:
Date of Birth:
Class level for upcoming Fall term:
Cumulative Grade Point Average:
Major field of study:
Do you read Braille?
Will you be a full-time student? (Note: full-time is considered 12 or more
credit hours per semester for undergraduates, and 9 or more credit hours for
graduate students.)
II. VISUAL STATUS
Please note: Legal blindness is defined as an individual who has a visual acuity of 20/200 or less in the corrected eye and/or 20 degrees or less visual field in the corrected eye. Legal blindness must exist in BOTH eyes to be considered eligible.
When did you begin having problems with your vision?
At what age did you become legally blind?
Cause of visual impairment:
Visual Acuity: Right Eye:
Left Eye:
Visual Field: Right Eye:
Left Eye:
Can you see well enough to tell whether the light is on or off?
Sometimes see steps going down?
Describe the types of mobility aids you use for travel: cane, guide dog, other devices.
Describe the media you choose for reading, the types of hardware or software you use including devices and technology you use including screen reader, notetaker, magnification devices, etc.
III. EDUCATIONAL BACKGROUND
A. (Entering Freshmen only)
High school currently attending:
Name:
City:
State:
Cumulative GPA (based on 4.0 scale):
B. College or technical college currently attending:
Name:
City:
State:
full-time? (Yes/No)
Cumulative GPA (based on 4.0 scale):
Date degree is expected:
Major(s) and Degree seeking (BS, MA, etc):
C. School you plan to attend in the fall of 2009 (if different from question
III. B.). Note: Proof of acceptance must be included with application materials. If you will not be notified of acceptance by the time you submit this application, please indicate the date you expect to receive notice from the school(s): 1st Choice:
Name:
City:
State:
Major and Degree:
full-time? (Yes/No)
Date degree expected:
2nd choice:
Name:
City:
State:
Major and Degree:
full-time? (Yes/No)
Date degree expected:
D. Please list all schools you have attended during the last four years if not mentioned above. Attach additional sheet, if necessary.
Name:
City:
State:
Dates (mo/yr) attended:
From:
To:
Cumulative grade point average (based on 4.0 scale):
Major and Degree or certificate received (if applicable):
IV. TEST RECORD INFORMATION
ACT Date tested:
Composite Score:
SAT Date tested:
Composite Score:
SAT II Subject:
Date tested:
Composite Score:
Other (GRE, GMAT, LSAT, etc.) specify:
Date tested:
Composite Score:
V. WORK EXPERIENCE
In the space provided, list any full-time or part-time work experience in the last ten years. Indicate whether this was summer employment or during the school year.
Work experience:
VI. EXTRACURRICULAR ACTIVITIES
A. Are you a member of the Arizona Council of the Blind or the American Council of the Blind?
B. Have you received an AzCB or ACB scholarship in the past? If so list the year(s). Your application will be shared with your state affiliate.
C. May we refer this application to another source of possible scholarship aid?
D. In the space below, list your extracurricular activities (school, religious, community, sports, organizations of the blind, recreation, etc.). Include the extent to which you have played a leadership role. A co-curricular transcript may be substituted.
Extracurricular activities:
Autobiographical sketch: Tell us about your personal goals, strengths, weaknesses, hobbies, honors, achievements, etc. Be sure to list the field or courses of study you are pursuing and explain why you have chosen it.
How did you hear about the AzCB or ACB scholarship program?
Please note: In some instances, scholarship awards may be considered taxable income by the Internal Revenue Service.