2009 Scholarship Application Form

Site Menu:

Accessibility Options
Home
Contacts
Programs & Committees
Publications
Membership
Conventions
Fund Raising
History
Resources
Calendar of Events
Site Map

Washington Council of the Blind Scholarship

Again in 2009, the Washington Council of the Blind plans to award scholarships to blind college or voc-tech school students in the State of Washington. In the past we have awarded scholarships of up to $4,000.

To help avoid confusion and minimize errors, please read through this application form completely before beginning to fill it out.
Applicant's Name (first, middle initial, last):
Address:
Street Address

Address Line 2

City

State

Zip Code

Country
Summer Address:
Street Address

Address Line 2

City

State

Zip Code

Country
Summer Daytime telephone number (with area code):
Summer Evening Phone Number (with area code):
Email:
Sex: Male Female
Birth Date:
Please enter the following information if you graduated from high school, or if you earned a G.E.D.
Name of High School:
Location of High School (City, State):
Year Graduated or G.E.D. Earned:
Please enter the name of the school you attended in 2008-2009, and provide your cumulative grade point average, based on a 4.0 scale.
School Attended in 2008-2009:
Location of School (City, State):
Cumulative Grade Point Average:
Please enter the name, location, and phone number of the school you plan to attend in 2009-2010. (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.)
School You Plan to Attend in 2009-2010:
Location of School (City, State):
School's ZIP Code:
School's Phone Number (with area code):
Check the item that best describes your school status for the Fall 2009 quarter: full time student involved in an internship attending school part-time and also working attending school part-time and not working other (please explain below)
Explanation if other:
Number of credits you will carry this fall:
Term: Quarter Semester
List other colleges or voc-tech schools you have attended (with dates).
School 1:
Location (City, State):
Attended from (month/year):
Attended To (month/year):
Cumulative GPA:
School 2:
Location (City, State):
Attended from (month/year):
Attended To (month/year):
Cumulative GPA:
School 3:
Location (City, State):
Attended from (month/year):
Attended To (month/year):
Cumulative GPA
Class level this fall quarter or semester:
Class: Freshman Sophomore Junior Senior Grad Other
If other, please explain:
Major field of study:
Degree expected:
Date degree expected:
Have you contacted the Department of Services for the Blind? If yes, outline financial aid to be supplied. If not, why not? Please enter your explanation below. Yes No
Explanation:
Please list below other sources of income and amounts:
Source 1:
Source 2:
Source 3:
Source 4:
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. Individuals who are legally blind in BOTH eyes are eligible to receive a scholarship. Certification of legal blindness must be provided. Information is given later in this form on how to provide this certification.
Are you legally blind? Yes No
Visual acuity in left eye:
Visual acuity in right eye:
Please check all of the methods you use for mobility. cane dog guide sighted guide
Other (please specify):
Please check all of the methods you use for reading. Braille recordings large print live reader computer screen reader programs or e-text
Other (please specify)
Please check all of the assistive devices you use. optical character scanner closed circuit TV computer screen enlarger program electronic Braille device
Other low vision aids (please specify):
Please attach transcript from last school attended. Transcripts do not need to be official and can be copies. You may submit your transcript online to jbrannon0612@comcast.net. Please send one- to three-page double-spaced typed statement (one thousand words) of your reasons for applying for this scholarship and how it will assist you to achieve your goals. Include a brief description of your background, education, work experience, economic status, strengths, weaknesses and what your personal goals are for the next five to ten years. Also add any special information such as awards and honors received, activities and community service, as well as any hobbies or interests. If you have received the WCB scholarship before, please describe how you were able to use the money, to improve your educational experience. Include any other information that you feel might assist us in our decision-making process. You may submit your personal essay online to jbrannon0612@comcast.net. Applicant MUST submit: (A) Two letters of recommendation, not from relatives. You may have your letters sent online to jbrannon0612@comcast.net. (B) Proof of legal blindness (see below). (C) Before receiving award, proof of fall registration. Applicant must be enrolled or planning to enroll in an accredited vocational school, college or university; and be a resident of Washington State. NOTE: These scholarships are given to provide for needs NOT covered by any federal, state or local agency funds. IMPORTANT: The rules of SSI require that award grants may not be spent on food, shelter or clothing. CERTIFICATION OF VISUAL STATUS What follows below is to be completed by an ophthalmologist, optometrist, physician, agency executive serving the blind, or other competent authority. This form may be submitted on line to jbrannon0612@comcast.net. This is to certify that the person named on this WCB Scholarship application, is known to me and is legally blind in that he/she 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. Or, the applicant is legally blind in both eyes. Name __________________________________________________ Title __________________________________________________ Agency __________________________________________________ Address __________________________________________________ __________________________________________________ City __________________________________ State _________ ZIP _______________ Phone __________________________________________ Signature _____________________________________________________________ Date _____________________ When you are satisfied that all of the information you have provided is correctly entered into this form, please click the SUBMIT button below. Thank you for your application.

Change the font size: + Larger Font | + Smaller Font

Washington Council of the Blind Scholarship

To help avoid confusion and minimize errors, please read through this application form completely before beginning to fill it out.

Please enter the following information if you graduated from high school, or if you earned a G.E.D.

Please enter the name of the school you attended in 2008-2009, and provide your cumulative grade point average, based on a 4.0 scale.

List other colleges or voc-tech schools you have attended (with dates).

Class level this fall quarter or semester:

Please list below other sources of income and amounts: