New Jersey Council of the Blind, Inc.
Scholarship Committee
Leigh Tilden
4 Utah Dr., Apt. A
Matawan, NJ 07747
Leighsue13@gmail.com
(732) 390-0989 Home
(908) 420-0558 Cell
Scholarship Application – 2016
Name: Last_________________ First ____________MI___
Address:
Street___________________________________________
________________________________________________
City______________________ State____ Zip Code_______
E-mail address ___________________________________
Telephone number ________________________________
Scholastic Record:
High School Attended ______________________________
High School Address _______________________________
________________________________________________
Dates attended ____________Year Graduated __________
Grade Point Average________ Class Rank ___ out of _____
College attended __________________________________
College Address ___________________________________
________________________________________________
Dates attended ___________________________________
Grade Point Average ________ Class Rank ___ out of ____
Please tell us about any SAT, ACT, GRE ore other college
entrance tests you have taken in the last two years.
Name of test
Date taken
Scores
________________________________________________
________________________________________________
________________________________________________
________________________________________________
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________________________________________________
________________________________________________
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Please tell us about any extracurricular activities you have
taken part in and any offices you have held in school and/or
community organizations.
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
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Please list any honors or awards you have received
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Please tell us about any volunteer or service activities you
have engaged in.
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
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__________________________________
Proof of blindness or visual impairment: Have attached form
completed by a doctor or attach certification of blindness
from the NJ Commission for the Blind and Visually Impaired.
Do you use a guide dog? Yes_____
No__________
Please have three letters of character reference, at least one
from a school councilor or teacher, none from family
members sent to us on the Letter of Reference form.
Selected applicants will be invited to a telephone or inperson interview with members of the NJCB Scholarship
Committee and Board of Trustees.
All materials must be received by May 1, 2016 to be
considered for the scholarships. All materials should be sent
to:
New Jersey Council of the Blind
Scholarship Committee
Leigh Tilden
4 Utah Dr., Apt. A
Matawan, NJ 07747
Or Email as attachment in MS Word to:
Leighsue13@gmail.com
Scholarship recipients will be announced in June and
recipients and their families will be invited to a July meeting,
ceremony, and picnic where the scholarships will be
awarded.
Recipients must agree to attend at least one NJCB meeting
in the year following the award to report on their
experiences. They are also asked to write a brief article on
a subject of their choice for the NJCB Chronicle.