Scholarship Guidelines

MISSOURI COUNCIL OF THE BLIND SCHOLARSHIP PROGRAM GUIDELINES

MISSOURI COUNCIL OF THE BLIND
SCHOLARSHIP PROGRAM GUIDELINES
Adopted October 10, 2002

I. ELIGIBILITY

A. Who is eligible to be considered for an MCB Scholarship?

Visual acuity of 20/200 or less in the better corrected eye or a visual field of 20 degrees or less
in the better corrected eye.

II. WHEN ARE SCHOLARSHIPS AVAILABLE?

A. When and How Do I Apply?

1. Scholarship applications are available after January the first from the MCB office.

aa@moblind.org;

Missouri Council of the Blind
5453 Chippewa Street
St. Louis, Mo 63109.

3. application must be returned to the chairperson of the Scholarship Committee by June 1.

4. Scholarship funding will be awarded for the upcoming school year.
III. FACTORS TO BE CONSIDERED BY THE SCHOLARSHIP COMMITTEE

IV. WHICH DOCUMENTS SHALL BE SUBMITTED FOR CONSIDERATION?

C. One (1) letter of recommendation from a current or recent instructor

MISSOURI COUNCIL OF THE BLIND SCHOLARSHIP PROGRAM APPLICATION

MISSOURI COUNCIL OF THE BLIND
SCHOLARSHIP PROGRAM APPLICATION
Adopted October 10, 2002

I. PERSONAL DATA

A:

NAME OF APPLICANT:

ADDRESS:

CITY:

STATE:

ZIP CODE:

SUMMER ADDRESS IF DIFFERENT FROM ABOVE:

DATE OF BIRTH:

Have you received MCB Scholarships previously? Yes/No. If yes, please indicate year awarded and amount received:

Are you a member of MCB? Yes/No.

U.S. Citizen? Yes or No. If no, give alien registration number:

II. VISUAL STATUS

Describe the cause and degree of visual impairment: Describe the cause and degree of visual impairment:

III. EDUCATIONAL BACKGROUND

A:

1. School in which you are presently enrolled: Name of School:

2. City:

3. State:

4. Cumulative grade point average (based on a 4.0)

5. Major:

6. Full or part time:

7. Certificate:

8. Presently seeking BS, MA, etc.:

9. Date degree expected:

10. If you are entering this school as a freshman or transfer student, proof of acceptance must be included with your application materials. If you have not been notified of your acceptance as of the date that you are submitting this application, please indicate below the date on which you expect to receive notice from the school. Date:

B:
List any other secondary or post secondary schools you have attended. (Include
additional typed pages if necessary.)

1. Name of School:

2. City:

3. State:

4. Zip Code:

5. Dates attended:

6. Cumulative grade point average (based on a 4.0)

IV. TEST RECORD INFORMATION

A: ACT:

1. ACT Date Tested:

2. ACT Composite Score:

B: SAT:

1. SAT Date Tested:

2. SAT Composite Score:

V. Work Experience

List all full or part-time work experience. Indicate whether this was summer employment or during the school year.

VI. Extracurricular Activities

List all major outside activities (school, religious, community-etc., sports, organizations of the blind, recreation, etc.). Include extent to which you have played a leadership role.

VII. CERTIFICATION

To be completed by an ophthalmologist, optometrist, physician, agency executive
serving the blind or other competent authority.
This is to certify that the person named on this 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 better
corrected eye and/or 20 degrees or less visual field in the better corrected eye.

Name:

Title:

Address:

Phone:

Date:

Signature:

Print and mail to:
Dr. Jarrell Holt
C/O MCB
5453 Chippewa
St. Louis, MO. 63109
Phone: (314) 832-7172

RELEASE OF INFORMATION FORM

*Applicant is to fill in the name, address and phone number of the appropriate agency,
organization, business or physician; sign and date the Release Form and enclose
it with the application.

This is to authorize:

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