Scholarship Application

Scholarship Application

Please complete the following form.

Name
Home Address (including city, state, and zipcode)
Primary Phone
Date of Birth
School Currently Attending
School Address (including city, state, and zipcode)
School Phone
Class Standing (e.g., freshman, senior, etc.)
Cumulative GPA
School you will attend in the fall of 2025
State Your Major (If in high school, state your proposed major when you enter college)
Vocational Goal
Awards and Honors (you may email a separate list if necessary)
Community Service (you may email a separate list if necessary)
When did you become legally blind (year)?
Visual Acuity
Cause of Blindness