American Council of the Blind
2016 Scholarship Application Program
Dear applicant:
Thank you for applying to the American Council
of the Blind Scholarship Program. Please take a
few moments to review the critical application
instructions that follow prior to proceeding to the
online application. Doing so will assure that you
have organized yourself in such a manner that
you have submitted all required documentation in
a timely manner. Please copy and save or
download the MS Word large print copy of this
instruction page prior to proceeding so that you
may reference them as needed.
Scholarship application instructions:
The American Council of the Blind scholarship
application process must be completed online.
Only approved supplements will be accepted by
regular mail. See the mailing address below for
submission of the supporting documents.
Incomplete forms will not be processed and
considered for review. Please do not leave any
questions blank.
Include the following with your completed
application:
1. Autobiographical sketch (details found in
online application)
2. Certification of legal blindness from an
ophthalmologist, optometrist or physician. (This
hard copy letter may be mailed.)
3. Certified transcripts from the school you are
currently attending. Entering freshmen, please
include high school transcripts; graduate
students, please include undergraduate
transcripts. Unless extenuating circumstances
exist, a 3.3 cumulative grade point average is
required. (This hard copy letter may be mailed.)
4. Two letters of recommendation from a current
or recent instructor, career counselor or
employer. (Microsoft Word or Rich Text formats
will only be accepted and can be emailed
separately to: deetheien@acbes.org.)
5. Proof of acceptance from a post-secondary
school. Entering and transferring students must
submit a notice or letter from the admissions
office certifying acceptance or consideration for
admission. If not available at the time the
application is submitted, it must be submitted as
soon as it is available. Students continuing at the
same school attended during 2015 do not need to
submit this document. (Microsoft Word or Rich
Text formats are preferred and can be emailed
separately to deetheien@acbes.org.)
Completed application supplements (only) that
are not able to be emailed must be postmarked no
later than Tuesday, March 1, 2016, to:
American Council of the Blind Scholarship
Program,
Attn: Dee Theien
6300 Shingle Creek Parkway
Suite 195
Brooklyn Center, MN 55430
Online applications must be submitted by 11:59
PM (CST) Tuesday, March 1, 2016. If you wish to
check on whether all your application information
was received, you may call Dee Theien after
March 14, 2016 at (612)332-3242 between the
hours of 9:00 a.m. to 1:00 p.m. (CST).
 After having read these scholarship
instructions, you may complete the scholarship
application at
http://www.acb.org/scholarapplication.
Remember you may download the instructions
to save. On the application you will be asked to
confirm you have read these instructions.
American Council of the Blind
2016 Scholarship Application
1: Personal Data
I confirm I have read the 2015 ACB Scholarship
instructions.
Name: (First, Middle, Last)
Gender:
Date of birth:
E-mail:
Mailing Address: C/O
Street:
City:
State:
Zip Code:
Cell Telephone Number:
Landline Telephone Number:
Major field of study:
Minor field of study:
Cumulative Grade Point Average: (Based on a 4.0
scale)
Class level for upcoming fall term, check one:
Vocational/Technical
Entering Freshman
Full time
Part time
Undergraduate
Full Time
Part time
Graduate
Full Time
Part time
(Note: Full Time is considered 12 or more credit
hours per term (semester or quarter) for
undergraduates and 9 or more credit hours for
graduate students.)
Are you working full time (32 or more hours per
week) and attending school?
Yes
No
II: Visual Status
Please note: Legal blindness is defined as an
individual who can not see better than 20/200 in
the best eye with glasses or contact lenses or
whose visual field in the best eye is 20 degrees or
less at the widest diameter with glasses or
contact lenses.
When did you begin having problems with your
vision?
At what age did you become legally blind?
(Please include correct information on the
cause(s) of vision loss, visual acuities and visual
fields. Do not refer to the eye report that must be
submitted.)
What is the cause(s) of visual impairment?
Visual Acuity:
Right Eye
Left Eye
Visual Field:
Right Eye
Left Eye
Can you see well enough to tell whether the light
is on or off?
Yes
No
Please describe the types of mobility aids you use
to travel: (Check all that apply.)
Cane
Dog guide
Sighted guide
Low vision aids (specify)
Other devices (specify)
Please describe the types of adaptive
communication tools that you use. (Check all that
apply.)
Braille
Screen readers
Large print
Note takers
Electric readers
Magnification devices
Other (specify)
III: Education Background
A. (Question A is for entering freshmen Only.)
High school currently attending: Name:
City and State:
Cumulative GPA (based on a 4.0 scale):
B. University/College or Vocational/Technical
school currently attending: Name:
City and State:
Full time or Part time
Full time
Part time
Cumulative GPA (based on a 4.0 scale):
Date degree is expected:
Major(s) and degree seeking: (BS, MA, etc):
C. University/College you plan to attend in the fall
of 2016, if different from question III B. Note:
Proof of acceptance must be included with
application materials. If you will not be notified by
the time you submit this application, please
indicate the date you expect to receive notice
from the school(s).
1st choice: Name:
City and State:
Major and degree:
Full time or part time
Full Time
Part time
Date degree expected:
2Nd Choice: Name:
City and State:
Major and degree:
Full time or part time
Full time
Part time
Date degree expected:
D. Please list any other schools you have
attended during the last four years if different
from above.
Name:
City and State:
Dates (mo/yr) attended: From:
Dates (mo/yr) attended: to:
Cumulative GPA (based on a 4.0 scale):
Major and degree or certificate received (if
applicable):
IV: Test Record Information
ACT Date tested:
Composite Score:
SAT Date tested:
Composite Score:
SAT II Subject:
Date tested:
Composite Score:
Other (GRE, GMAT, LSAT, etc.) specify
Date tested:
Composite Score:
V: Work Experience
Please list any full-time or part-time work
experiences that you have had in the last ten
years. Indicate whether this was summer
employment or during the school year.
VI: Extracurricular Activities:
A. Please list your extracurricular activities
(school, religious, community, sports,
organizations of the blind, recreation, etc).
Include the extent to which you have played a
leadership role. A co-curricular transcript may be
submitted and can be inserted into your
application.
VII: American Council of the Blind
Involvement:
A. Are you a member of the American Council of
the Blind?
ACB scholarship winners are expected to attend
the ACB National Conference and Convention
unless there are circumstances beyond their
control and with the approval of the organization.
B. Will you be able to attend the ACB National
Conference and Convention in Minneapolis, MN,
July 2-9, 2016?
C. Have you received an American Council of the
Blind Scholarship in the past? If so list what
year(s).
D. May we refer this application to another source
of possible scholarship aid?
E. Your scholarship information will be shared
with your state affiliate of ACB unless you request
that it not be shared.
F. How did you hear about The American Council
of the Blind scholarship program? Check all that
apply:
Vision Teacher
School Counselor
Rehabilitation Counselor or Services
Office of Students with Disabilities
ACB Website
Other, please specify
VIII: Autobiographical Sketch:
Autobiographical sketch: No more than 500
words containing information about you.
Tell us about your personal goals, strengths,
weaknesses, hobbies, honors, achievements, etc.
Be sure to list the field or courses of study you
are pursuing and explain why you have chosen it.
Please refer to the instructions at the beginning of
the application to ensure that your application is
complete. Please review the entire scholarship
application for accuracy and completeness.
Before submitting your application, you should
make a copy for your records.