Jeff Thom
President
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CALIFORNIA COUNCIL OF THE BLIND
EXECUTIVE OFFICE
1303 J Street, Suite 400
Sacramento, CA 95814-2900
FAX 916-441-2188
E-Mail: ccotb@ccbnet.org
Webpage: www.ccbnet.org
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CALIFORNIA COUNCIL OF THE BLIND
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1303 “J” Street, Suite 400
Sacramento, CA 95814-2900
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800-221-6359
916-441-2100
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SCHOLARSHIP AWARDS APPLICATION
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FOR SCHOOL YEAR 2016 – 2017
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The California Council of the Blind gives a number of
awards to the most deserving student applicants who
are legally blind residents of California. Awards are
made to students who will enter or continue
undergraduate or graduate studies at an accredited
college, university, or vocational school.
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Applicants must be enrolled on a full-time basis.
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It is not required that the institution attended be
located in California.
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These awards are granted in two parts, half in the Fall
and half in the Spring upon receipt of proof of
enrollment. Awards will be granted on the basis of
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academic performance and other factors. Your
application must be typed or it will be rejected.
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If you have previously applied, you must submit an
entirely new application, including supporting
documentation.
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Your application may be denied if it is incomplete.
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If a requested item is not applicable, please provide a
brief explanation.
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List of items required for the application process
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1. A completed (typed or word processed)
application form
2. Official transcripts (with institution’s seal)
3. Doctor’s verification of legal blindness (this
letter must clearly state the individual is legally
blind)
4. Letter(s) of recommendation (Optional)
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Your application will be rejected if you fail to include a
Doctor’s statement or a statement from a qualified
professional, such as a Rehabilitation Counselor,
certifying that you are legally blind.
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To qualify to receive a scholarship award, you must
be a full-time student registered for at least 12
semester/8 quarter units for each term of the entire
academic year or 9 semester/6 quarter units each
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term for graduate students. If you believe that you
have extenuating circumstances, such as additional
disability or job requirements that prevent you from
meeting this requirement, please provide a complete
explanation of your situation.
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If your award is approved, you must submit, for each
half of the award, written proof of enrollment. This
proof of enrollment must be signed by the Registrar
on school letterhead and must include a complete list
of classes and total units to be taken.
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When beginning or continuing work on a thesis or
dissertation, you must provide a letter from the Dean
or Department head stating that you are working on
your thesis or dissertation.
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You must provide a separate letter for each half of
your award. No monies will be allocated if proof of
enrollment or continuing thesis or dissertation studies
is not provided.
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Application date:
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Applicant’s full name:
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Age:
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Gender:
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Permanent California residence address:
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Address Line 2:
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City:
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Zip Code:
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Telephone:
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Summer address: (if different)
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Address Line 2:
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City:
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Zip Code:
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Telephone:
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E-mail Address:
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School address: (if different)
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Address Line 2:
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City:
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Zip Code:
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Telephone:
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E-mail address:
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Freshmen applicants please provide:
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High School attended:
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Name:
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Address:
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Address Line 2
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City:
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State:
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Zip Code:
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List previous colleges attended: (years attended and
total units completed)
(Please specify quarter or semester units)
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College Name:
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From:
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To:
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Units Completed:
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College Name:
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From:
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To:
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Units Completed:
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College Name:
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From:
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To:
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Units Completed:
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College now attending:
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City:
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State:
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Units Completed:
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College you will attend this summer:
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Total number of units completed:
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Cumulative all college grade point average:
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Total number of units carried this term:
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Total number of units you will carry this Fall:_______
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(If your school measures course work in hours, please
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provide the total units you will receive.)
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State your Subject/Major:
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Are you a client of the California Department of
Rehabilitation? YES
NO
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If yes, please provide the name of your
Rehabilitation Counselor. Your answer will not
affect the validity of your application.
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Provide a typewritten statement (Not more than 500
words and double spaced) giving your purpose in
undertaking college work and your vocational goals.
(For previous applicants, your prior statement is not
acceptable.)
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You may also mention your interests and avocations.
As they relate to your chosen major.
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If you are a member of the California Council of the
Blind, we would appreciate a current letter of
recommendation from the President of your chapter
or affiliate. If you are not a member but you know a
member, we would appreciate a current letter of
recommendation from that person. You may also
send letters from teachers or others. Even if you have
applied previously, please provide updates as
typewritten information.
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In order to process your application, this application,
transcripts and records must be submitted to the
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California Council of the Blind office by July 1, 2016 at
5 pm. You may submit the application via electronic
format, but all supporting documentation
must be submitted in hard copy. However, if
transcripts are not available at that time, you may
submit them by no later than July 15, 2016.
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We will attempt to arrange a telephone interview.
Accurate summer telephone numbers and addresses
are vital to the processing of this application
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(revision 04/01/16)