2019 Scholarship Application – Washington Council of the Blind

Please take a few moments to review the instructions before proceeding to the online application. This will ensure you have submitted all required documentation in a timely manner. To complete this application please enter the required information in the fields below. Fields marked with an asterisk (*) are required fields; these fields must be completed in order to successfully submit your application.

Upon successful receipt of your application packet you will receive a message that your application has been successfully submitted. If you do not receive this message, then your application was not received and you should email Kim Moberg: scholarshipwcb@yahoo.com so that she can verify the status of your application. If necessary she may have you take additional steps in order to get your application submitted.

Name *

Sex *

Male

Female

Birthdate *

Contact Details

Address *

Apt, suite, etc.

Country

City

State

Zip code

Email *

Daytime Telephone Number (With area code) *

Evening Telephone Number (With area code) *

Education

The following Question is for entering freshmen Only)

Name of High School you are currently attending *

City *

State *

Year of Graduation or G.E.D.

Please enter the name of the school you attended during the 2018/2019 school year, and provide your cumulative grade point average based on a 4.0 scale:

Name of School (2018 - 2019 school year)

City

State

Cumulative Grade Point Average *

Please enter the name, location, and phone number of the school you plan to attend in 2019-2020. (Note: Proof of acceptance must be included with your application materials. If you will not be notified of acceptance by the time you submit this application

Name of school you plan to attend (2019 - 2020 school year)

City

State

Zip/Postal Code

School Registrar's phone number with area code

Select the item that best describes your school status for the Fall 2019 quarter or semester: *

Full time student

Involved In an Internship

Attending school part-time and also working

Attending school part-time and not working

Replace with other School Status

Your school considers Fall term to be a:

Quarter

Semester

Number of credits you will carry in Fall term

List other colleges or vocational/technical schools you have attended. (Include dates of attendance):

Name of school 1

City

State

Attended from Date

Attended to date

Cumulative Grade Point Average for school 1 *

Name of school 2

City

State

Attended from date

Attended to date

Cumulative Grade Point Average for school 2 *

Major field of study *

Minor field of study

Date Degree Is Expected:

Have you contacted the Washington Department of services for the Blind?

Yes

If yes, outline financial aid to be supplied

If no, please explain

Income

Please list any other sources of funding and amounts.

Visual Impairment

Please note: Legal blindness is defined in the cover letter. Certification of legal blindness must be provided.

Are you legally blind?

Yes

Visual acuity in right eye *

Visual acuity in left eye *

Visual field in left eye *

Visual field in right eye *

Please check all of the methods you use for mobility *

White cane

Dog guide

Sighted guide

Other

Please provide more information if you checked "other"

Please provide more information if you checked "other”

Please check all of the assistive devices you use

Optical character scanner

Closed Circuit TV

Computer screen magnification program

Electronic Braille Device

Other low vision aids

Please provide more information if you checked "other low vision aids"

How did you hear about the Washington Council of the Blind scholarship program?

Supporting Documents

Instructions for document submission

Please provide transcripts from last school you attended. Transcripts do not need to be official, and can be copies of the original. If you are having difficulties uploading your document, please contact Kim L. Moberg at the phone number at the bottom of this application

Please send a one thousand word essay stating 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 and 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, activities, community service, hobbies, and 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 you feel might assist the scholarship committee in the decision-making process. You may submit your personal essay on line. If you are having issues uploading your document contact Committee Chair Kim Moberg at the email at the bottom of this application

As a final reminder: to be eligible applicants must submit:

Personal essay. This essay can be uploaded with this application. If you are having difficulties uploading your document, please contact Kim L. Moberg at the phone number at the bottom of this application
Certification by your ophthalmologist, optometrist, physician, agency executive serving the blind or any other qualified individuals of legal blindness in both eyes. This certification can be uploaded here on this application. The certification of legal blindness must include the name and title of the person certifying the legal blindness, his or her address, phone number, and a statement regarding the visual acuity and or visual field of each eye. This letter must be as current as possible.
Transcripts from the school you are currently attending. Entering freshman and sophomores, please include high school transcripts; graduate students, please include undergraduate transcripts. Transcripts do not need to be official versions and can be uploaded with this application
Two letters of recommendation from a current or recent instructor, career counselor or employer. Letters of recommendation should be current and describe the applicants character, contributions, and successes. Microsoft word for Rich Text formats will be excepted and can be uploaded with this application

Letter 1 of recommendation from a current or recent instructor, career counselor or employer.

Letter 2 of recommendation from a current or recent instructor, career counselor or employer.

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 2018-2019 also need to submit a notice from the admissions office stating that they will be attending school during the 2019-2020 academic year. You may upload your document along with this application

Proof of acceptance to school for 2019 - 2020 academic year *

Transcript from Previous School Year.

Certification of legal blindness *

Letter of Reference 1 *

Letter of Reference 2 *

Personal Essay *

Form Sumission

The completed application and supplements must be submitted no later than 11:59 PM Saturday June 1, 2019

Note: These scholarships are given to provide for needs not covered by any federal, state or local funds.

When you are satisfied that all of the information you have provided is correctly entered into this form You will then be asked to click the “submit” button to save your application.

Kim L. Moberg 2019 WCB Scholarship Committee Chair
360-981-9944. scholarshipwcb@yahoo.com

Thank you for your application.