Coca-Cola & Kentucky Office for the Blind
Scholarship Application
Date of Application:
Full Name of Applicant:
Home Address:
Street(Apt)City/StateZip
Alternate Address:
Street(Apt)City/StateZip
Home Phone:Mobile Phone:
Email:Counselor Name:
Education
High School:
Full Address:
Date of graduation:
Name of College:
Address of College:
StreetCity/StateZip
Major or Subject of Study:
Degree earned or number of hours earned:
Specialized Training or Trade School name:
Address:
Major or Subject of Study:
Degree earned or number of hours earned:
Other Education:
School that you plan to attend beginning Fall 2017:
Address:
Date Degree Expected:
Employment Experience (Beginning withmost recent)
Dates Employed:
Company Name:
Location:
Rote/Title:
Job notes, tasks performed and reason for leaving:
Dates Employed:
Company Name:
Location:
Rote/Title:
Job notes, tasks performed and reason for leaving:
Dates Employed:
Company Name:
Location:
Rote/Title:
Job notes, tasks performed and reason for leaving:
Dates Employed:
Company Name:
Location:
Rote/Title:
Job notes, tasks performed and reason for leaving:
Dates Employed:
Company Name:
Location:
Rote/Title:
Job notes, tasks performed and reason for leaving:
Attach additional sheets for continued employment experience
Please choose one the following below for your essay (500 words):
a)Describe a person who embodies the idea of excellence you try to carry for yourself. This person might be a role model, an historical figure, or even a fictional hero-someone who you are inspired by and admire beyond your family members.
b)What activities (academic, athletic, cultural, community-related, occupational, etc.) do you participate in that you feel most builds and reflects your character?
c) If you were mayor of your hometown, what changes would you make? Why?
d)Describe your academic and career goals and your plans to achieve them and discuss any of your extracurricular/volunteer activities (both on and off campus) that you may perform.
Submission Checklist:
Photocopy of state issued identification (must be resident of Kentucky)
Two (2) letters of recommendation
Acceptance letter from college
Proof of legal blindness (click here for definition & form)
Completed Essay
Current transcript (official copy)
Completed Application Form
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