Eligibility Criteria:
All applications and supporting documentation must be recieved electronicly or postmarked by mail no later than March 1, 2012. Applications can be mailed to: Arizona Council of the Blind, Inc. 3124 E. Roosevelt St., Ste. 4 Phoenix, AZ 85008-5088
If you fill out an online application all supporting documentation can be emailed as attachments, in Word or PDF formats, to scholarship@azcb.org.
Only fully completed applications, with all supporting documents, will be considered. Applicants will be notified by April 1 if selected to receive a scholarship
2012 Scholarship Packet Checklist:
* REQUIRED FIELD: Your Full Name: Full Name Street Address and Unit if needed: Address and Unit City: City State: State Zip Code: ZIP Code
Telephone Number: * REQUIRED FIELD. Daytime Phone Number: Evening Phone Number: Cell Phone Number:
Permanent and/or legal address and telephone number (if different from above): Your Legal Address if different from above: City: State: Zip Code: Phone number: Male/Female: Female Male Date of Birth: Date of Birth Class level for upcoming fall term: Cumulative Grade Point Average Based on 4.0: Major field of study: Major Field of Study Do you read Braille? Yes I Read Braille No I Don't 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.) Yes I will be full time No I will not be full time
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: Visual Acuity Left Eye: Visual Field Right Eye in degrees: Visual Field Left Eye in degrees: Can you see well enough to tell whether the light is on or off? Yes I can see light Yes I can see light No I can't see light No I can't see light 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.
A. (Entering Freshmen only)? High school currently attending: Name of High school currently attending: City: State: Cumulative GPA (based on 4.0 scale): Grade Point Average Based on 4.0
B. College or technical college currently attending: Name of College or technical college currently attending: City: State: full-time? (Yes/No) Cumulative GPA (based on 4.0 scale): Date degree is expected mm/dd/yyy: Major(s) and Degree seeking (BS, MA, etc): C. School you plan to attend in the fall (if different from question III. ). 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: Date proof of acceptance will be available if not available now mm/dd/yy?: Name of School attending in fall if different then III: City: State: Major and Degree: full-time? (Yes/No) Date degree expected: 2nd choice: Name of Second choice: 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 of an additional School: City: State: Dates (Month and /year) attended: From: To: Cumulative grade point average (based on 4.0 scale): Major and Degree or certificate received (if applicable):
ACT Date ACT of test: Composite Score: Date of SAT II Subject: Composite Score: Other Test (GRE, GMAT, LSAT, etc.) specify: Name of Other Test: Date tested: Composite Score:
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. 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.
A. Are you a member of the Arizona Council of the Blind or the American Council of the Blind? 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). ? Have you received an AzCB or ACB scholarship in the past? C. How did you hear about the AzCB Scholarship Program? How did you hear about the AzCB Scholarship Program? 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. 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. Autobiographical sketch: Describe 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. Describe how obtaining a scholarship would help your educational experience. Autobiographical sketch: Describe 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. Describe how obtaining a scholarship would help your educational experience. Comments"
Submit will send an E-mail of your request to the Scholarship Committee of the AzCB.
Return to AzCB Web Site