Office of Disability Services
9201 University City Boulevard, 230 Fretwell, Charlotte, N.C. 28223-0001
Tel: (704) 687-0040 (V/TTY) Fax: (704) 687-1395
www.ds.uncc.edu
SCHOLARSHIP PROGRAMS
Completed Applications Due: February 28, 5:00 pm
Scholarships Available through the Office of Disability Services
There are four separate financial need-based scholarships available through Disability Services. The
scholarships are: Central Lions Fund Scholarship, Carol Douglas Scholarship, Kristian Champion/Jeremy
Lewis Scholarship, and Lions Fund of the Piedmont scholarship. The minimum scholarship award is
$1,000. Review the information packet carefully as the scholarship applications have different
requirements.
Eligibility requirements for ALL Disability Services scholarships:
1. Have a documented disability & be registered with Disability Services
2. Be a legal resident of the United States or possess a valid student visa
3. Complete full application packet prior to deadline
4. Have documented financial need
5. Have a minimum cumulative GPA of 2.5 at UNC Charlotte
6. Be a current & ongoing undergraduate enrolled at UNC Charlotte with a min. 6 credit hours
7. Have no disciplinary actions on academic record
8. Sign Consent to Release Student Information
Scholarship Award:
Completed applications are due in the Office of Disability Services by 5 pm February 28. Recipients will
be notified via email by April 30. The scholarship money will be awarded for the following academic
year during the fall and spring semester. The student must remain enrolled both semesters during the year
of the award. Scholarships are not renewable, but students may reapply for the scholarship each year. A
Scholarship Selection Committee will decide which students are given awards.
SCHOLARSHIP APPLICATION CHECKLIST
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FAFSA, Financial Aid Reward Letter, and Student Aid Report (SAR)
Release of Information (included in this packet)
Application Form (included in this packet)
Personal Statement/ Essay (guidelines are included in this packet)
Resume
Transcript (unofficial)
Two Professional References (request included in this packet)
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Disability Services Scholarship Application Information
In order to apply for one of the scholarships available through Disability Services complete the
application that is included in this packet, write a personal essay (see criteria below), provide two
professional references, attach your financial need documentation, UNC Charlotte transcript, resume and
a signed consent allowing your information to be shared. All information is due in the Office of
Disability Services by February 28 at 5:00 pm. Late and incomplete applications will not be accepted.
Financial need documentation
Complete a current year Federal Application for Free Student Aid (FAFSA) in order to receive a Student
Aid Report (SAR). Provide the SAR and a copy of Financial Aid Reward letter (available in BANNER).
UNC Charlotte transcript
Your unofficial transcript can be obtained through BANNER. Print a copy and attach to the application.
Personal Statement/Essay
Write and attach a personal essay of 500 words or less. Please include the following information:
 Describe how your disability has impacted your life and its effect on you in the academic setting.
 Explain why you would benefit financially by receiving this scholarship. Please address any
specific financial needs that may not be met otherwise.
 Provide any additional information regarding your ambitions, goals, leadership roles, community
service and any other factors you would like to be considered during the selection process.
 If applying for the Kristian Champion/Jeremy Lewis Scholarship- respond to these two
additional questions. What is the biggest misconception others have about you? How can you
educate others about their misconception?
Resume
You can get help writing your résumé from The University Career Center, Atkins, 704-687-2231,
www.career.uncc.edu.
Two Professional References
Provide a professional reference from two individuals. See the guidelines on the lower portion of the
Professional Reference Release form in this packet. Reference letters must be included in the application
packet in sealed envelopes with references’ signature over the sealed envelope flap.
Judging Criteria
The Scholarship Selection Committee will use all of the information provided in the application to
identify the students most qualified. All components of the application are relevant.
Completed applications are due in the Office of Disability Services by February 28, 5:00 pm. If
mailing the application packet, allow sufficient time for delivery to arrive by February 28.
Applications can be turned in at the Disability Services front desk.
UNC Charlotte
230 Fretwell Building
9201 University City Boulevard
Charlotte, NC 28223
Disability Services Scholarship rev. 2014
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SCHOLARSHIP APPLICATION
Identify scholarship(s) for which you are applying: (check all for which you are applying)
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Central Lions Fund (eligibility requires a physical disability)
Carol Douglas (eligibility open to any type of disability)
Lions Fund of the Piedmont (eligibility requires a visual impairment)
Kristian Champion/Jeremy Lewis Scholarship (eligibility requires physical disability since birth)
Date: ______________________________ Student ID #__800________________________________
Name: _______________________________________________________________________________
Address:______________________________________________________________________________
_____________________________________________________________________________________
Cell/Home Phone Number: ______________________________________________________________
University E-Mail Address: _____________________________________________________________
College/Major: ______________________Cumulative GPA: __________Hours Complete:__________
Current classification:
Freshman
Sophomore
Junior
Senior
Career Goal: _________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Awards and Honors (attach list if necessary): ______________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Community Service (attach list if necessary): _______________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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Office of Disability Services
9201 University City Boulevard, 230 Fretwell, Charlotte, N.C. 28223-0001
Tel: (704) 687-0040 (V/TTY) Fax: (704) 687-1395
www.ds.uncc.edu
Professional Reference Release
Applicant Name: _________________________________ Date: ________________________________
Reference: ___________________________________________________________________________
I, _________________________________, hereby authorize, ___________________________________
(Applicant)
(Reference)
to provide the Scholarship Selection Committee with the following information applicable to my
professionalism and character as an applicant for the disability services scholarship.
___________________________________________
Applicant’s Signature
_____________________________________
Date
_____________________
The above named individual is applying for a scholarship through the Office of Disability Services.
Please follow the guidelines listed below for your reference letter. Please return this form and your
reference letter to the applicant in an envelope with your signature over the sealed closure. The applicant
will enclose the sealed envelope with his/her application packet. Thank you for your assistance.
Dear Professional ReferencePlease include the following information in your letter:
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
Your profession and current position
In what capacity have you known this applicant
How long have you have known this applicant
Applicant’s judgment, service to the community, and ethical conduct
Any notable strengths and/or weaknesses
Disability Services Scholarship rev. 2014
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Office of Disability Services
9201 University City Boulevard, 230 Fretwell, Charlotte, N.C. 28223-0001
Tel: (704) 687-0040 (V/TTY) Fax: (704) 687-1395
www.ds.uncc.edu
Professional Reference Release
Applicant Name: _________________________________ Date: ________________________________
Reference: ___________________________________________________________________________
I, _________________________________, hereby authorize, ___________________________________
(Applicant)
(Reference)
to provide the Scholarship Selection Committee with the following information applicable to my
professionalism and character as an applicant for the disability services scholarship.
___________________________________________
Applicant’s Signature
_____________________________________
Date
_____________________
The above named individual is applying for a scholarship through the Office of Disability Services.
Please follow the guidelines listed below for your reference letter. Please return this form and your
reference letter to the applicant in an envelope with your signature over the sealed closure. The applicant
will enclose the sealed envelope with his/her application packet. Thank you for your assistance.
Dear Professional ReferencePlease include the following information in your letter:





Your profession and current position
In what capacity have you known this applicant
How long have you have known this applicant
Applicant’s judgment, service to the community, and ethical conduct
Any notable strengths and/or weaknesses
Disability Services Scholarship rev. 2014
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Office of Disability Services
9201 University City Boulevard, 230 Fretwell, Charlotte, N.C. 28223-0001
Tel: (704) 687-0040 (V/TTY) Fax: (704) 687-1395
www.ds.uncc.edu
CONSENT TO RELEASE INFORMATION
I authorize the Office of Disability Services at UNC Charlotte to release specific information from the
application of (your name)_________________________________ to the Scholarship Selection
Committee. This information will remain confidential among committee members and will include the
following: financial information, academic records, work history, and personal references. Information
regarding your type of disability will be shared with the selection committees that have specific disability
requirements. The endowment funding organizations will also be notified of the scholarship award
recipients.
I further recognize that as a result of my association with the Office of Disability Services scholarship
program, my status as a registered student with a disability will be disclosed through my scholarship
award. The Office of Disability Services will not disclose disability specific information about award
winners.
This information is being provided as part of the Disability Services Scholarship selection process. My
consent is voluntary, and I realize that I may revoke this consent at any time except to the extent of
information that has already been released.
___________________________________
Applicant’s Name (Printed)
___800____________________________
Student ID #
___________________________________
Applicant’s Signature
__________________________________
Date
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