AMERICAN COUNCIL OF THE BLIND OF TEXAS (ACBT)
SCHOLARSHIP APPLICATION
2010-2011
ACBT subscribes to the mission statement of ACB and works to be an advocacy organization and positive, proactive support system to Texans who are blind or visually impaired. Our state motto is TEAM – Together Everyone Achieves More. Although the majority of members are blind or visually impaired, sighted persons who share the common goals and interests of our organization are also welcome to join. ACBT currently has nine chapters and six special interest affiliates.
PERSONAL INFORMATION
Name ______
Mailing Address ______
City/State/Zip ______
Area Code and Phone ______
Email Address ______
Date of Birth ______Age ______Sex ______
Marital Status ______# of dependents (if applicable) _____
FINANCIAL INFORMATION (Optional)
Please list all sources and amounts of support/income per academic year. Mark “0” for all sources you do not receive.
$ ______Applicant’s net wages from work (monthly)
$ ______Spouse’s net wages from work (monthly)
$ ______Social Security; i.e. SSI, SSDI, AFDC, etc. (monthly)
$ ______Scholarships (list by types): May use back of page.
If receiving any of the above, documentation must be provided
AMERICAN COUNCIL OF THE BLIND OF TEXAS (ACBT)
SCHOLARSHIP APPLICATION
2010-2011
DIVISION OF BLIND SERVICES INFORMATION
This section must be filled out by your Division of Assistive Rehabilitation (DARS)/Division of Blind Services (DBS) counselor.
DAR/DBS Counselor: please complete the information relating to vision and check types of aid received.
Documentation of legal or total blindness
Description/Name of visual impairment ______
Visual Acuity (right) ______(left) ______
Visual Field (right) ______(left) ______
Documentation of financial assistance
____ Tuition/fee exemption or tuition or fee payment
____ Books and Supplies voucher
____ Extra expenses money at beginning of semester
____ Reader services
____ Tutorial services
____ Transportation (on a monthly basis)
______
DARS/DBS Counselor’s SignatureDate
DARS/DBS Counselor’s Phone Number ______
DARS/DBS Counselor’s Email address ______
Mail application and all supporting documentation to:
Joyce Watson, Scholarship Chairperson
American Council of the Blind of Texas
4631 Connorvale
Houston, TX 77039
Please address any questions to Joyce Watson at 281-449-0915 or at
AMERICAN COUNCIL OF THE BLIND OF TEXAS (ACBT)
Teacher/School AdministratorLetter of Recommendation Form
(This form must be attached to letter of recommendation)
Scholarship Applicant for 2010-2011
ACBT subscribes to this mission statement and works to be an advocacy organization and positive, proactive support system to Texans who are blind or visually impaired. Our state motto is TEAM – Together Everyone Achieves More. Although the majority of members are blind or visually impaired, sighted persons who share the common goals and interests of our organization are also welcome to join. ACBT currently has nine chapters and six special interest affiliates.
Applicant’s Name: ______
Name of High School or College: ______
Name of Teacher/School Administrator: ______
Title and Department: ______
Telephone ______E-mail ______
The student whose name appears above is applying for an American Council of the Blind of Texas scholarship award, presentedto entering college freshmen, current college students, and students enrolled in vocational or technical programs. Your recommendation offering specific information about the accomplishment and qualifications of the applicant, and your comments will be most helpful to the selection committee in its evaluation of applicants.
Your recommendation of the applicant’s performance, abilities and personal qualities will be carefully reviewed. If you are aware of contributions the applicant has made to the school or community, please comment of his/her talent, dedication and effectiveness in your letter of recommendation.
Please address any questions to Joyce Watson at or phone call to 281-449-0915.
AMERICAN COUNCIL OF THE BLIND OF TEXAS (ACBT)
Letter of Recommendation Form
(This form must be attached to letter of recommendation)
Scholarship Applicant for 2010-2011
ACBT subscribes to this mission statement and works to be an advocacy organization and positive, proactive support system to Texans who are blind or visually impaired. Our state motto is TEAM – Together Everyone Achieves More. Although the majority of members are blind or visually impaired, sighted persons who share the common goals and interests of our organization are also welcome to join. ACBT currently has nine chapters and six special interest affiliates.
Applicant’s Name: ______
Name of High School or College: ______
______
Name of Person Making Recommendation: ______
Title: ______
Telephone ______E-mail ______
The student whose name appears above is applying for an American Council of the Blind of Texas scholarship award, presentedto entering college freshmen, current college students, and students enrolled in vocational or technical programs. Your recommendation offering specific information about the accomplishment and qualifications of the applicant, and your comments will be most helpful to the selection committee in its evaluation of applicants.
Your recommendation of the applicant’s performance, abilities and personal qualities will be carefully reviewed. If you are aware of contributions the applicant has made to the school or community, please comment of his/her talent, dedication and effectiveness in your letter of recommendation.
Please address any questions to Joyce Watson at or phone call to 281-449-0915.
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