DON HENARD MARION LIONS CLUB SCHOLARSHIP
FOR THE VISUAL/HEARING IMPAIRED
The Don Henard Marion Lions Club Scholarship winner is entitled to a $1,000 award given once to agraduating senior at Marion High School. Students who apply for this scholarship must meet the generalguidelines for visual or hearing impairment.* Recipient(s) will be required to provide an end of semester gradecard before the actual monetary award is given.
TYPED APPLICATIONSmust be turned in by the deadline. No incompleteapplications will be considered. Please do not include photos, a cover page, and please do notplace your application in a binder. Please staplepages together in upper left-hand corner.
Applicants:
• Must submit a completed TYPED application, which includes, among other points, a short essay oncareer goals and information of financial need.
• Must submit an official high school transcriptshowing a minimum of 8 mainstream classes withACT score, and a letter of admission from their chosen college/university. ACT score should besubmitted, and GPA at least 3.0 or higher.
• If applicable, applicants must provide letter from ENT physician or current audiologist thatincludes current audiogram (aided & unaided), and age of diagnosis. Hearing impaired applicantsshould also include any communication restrictions; for example-auditory verbal, American SignLanguage, cued speech, total communication, or any type of communication.
• If applicable, applicants must provide letter from current Ophthalmologist or Optometrist thatincludes current vision (corrected and uncorrected) or description of field of vision loss and ageof diagnosis.
Criteria for awarding the scholarship will be weighted in the following manner:
10% ACT Scores
10% Essay of Career Goals
15% Curriculum in High School
15% Extracurricular Activities and Work
25% Grade Point Average
25% Financial Needs
* Scholarship applicants must be diagnosed with either:
Degree of deafness from mild (26-40) to profound (91+)
-OR-
Vision impairment being 20/70 or worse with correction or have a field of vision loss.
Application Deadline is February 27, 2015
DON HENARD MARION LIONS CLUB SCHOLARSHIP
FOR THE VISUAL/HEARING IMPAIRED
APPLICATION FORM
NAME:
ADDRESS:
TELEPHONE:
EMAIL ADDRESS:
1. Please list your ACT score (please attach copy of ACT results)
(provide copy of ACT results)
2. List Cumulative High School Grade Average through first semester of senior year:
(provide high school transcript)
3. List Extra-Curricular activities, including offices held, awards received, etc.: (provide response below)
4. Work Activities: List jobs you have held or currently hold. Describe the type of employmentand average number of hours worked weekly. (provide response below)
5. Family Income: (Combined)(Place an X on the appropriate income category)
Under $15,000:
$15,000 - $25,000:
$25,001 - $35,000:
$35,001 - $50,000:
$50,001 - $75,000:
$75,001 - $100,000:
Over $100,000:
6. Total number of household members/ dependents for Family Income:
7. Number of household members currently attending college:
8. Description of financial need. (completion of this question is optional) (below)
-PLEASE ATTACH TYPED ESSAY ON CAREER GOALS-
1/31/13