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Academic Scholarship Application

Instructions:

  1. Complete the application form and secure the required materials. Incomplete applications will not be considered.
  2. Send completed application and materials to: Scholarship Committee, Memorial Foundation for the Blind, Inc., 799 West Boylston Street, Worcester, MA 01606.
  3. Completed application must be postmarked no later than April 1 of current year.
  4. All applicants will be notified via phone or mail of the decisions by June 1, of current year.

Terms and conditions of scholarship award:

  1. The applicant must be a resident of Worcester County. (For students living on campus, residence is defined as the students HOME town.)
  2. The applicant must be a student who is blind or visually impaired within the legal definition of blindness.
  3. Scholarships will be awarded for one (1) academic year on a needs/merit basis.
  4. The award of scholarships and scholarship amount will be at the discretion of the Scholarship Committee and the approval of the Board of Directors upon receipt of all supporting documents. A scholarship may be awarded up to the amount of $1,000.00.
  5. A scholarship recipient may apply for renewal, using the same process outlined herein. The applicant is expected to be in good academic standing according to the academic cumulative Grade Point Average (GPA) established by the prospective college/university.
  6. Payment will be made directly to the recipient upon enrollment.
  7. A personal interview may be required at the discretion of the Scholarship Committee.
  8. In fulfilling its role in the awarding of scholarships, the Scholarship Committee does not discriminate on the basis of race, sex, age, ethnic background, or socioeconomic status.

All materials received by the Scholarship Committee will remain confidential to that committee.

Application Requirements:

Please submit the following materials postmarked by the deadline stated above.

  1. Completed application form. (If you would like to receive the application materials in electronic or Braille format, please contact Larry Raymond at 508-753-8097.)
  2. Certified transcripts.
  3. Proof of acceptance at an accredited college, university or technical school.
  4. Proof of legal blindness (MCB Certificate of Blindness).
  5. Proof of residency in Worcester County.
  6. List of all other scholarships applied for (include name and address of scholarship/organization or foundation.
  7. Essay.

* Required

1. Personal Data

Name
What is your name?

Address
What is your primary address, include suite apartment number

City
City

State
State

Zip Code
Zip Code

Day Phone
Day Phone

Evening Phone
Evening Phone

Summer Address (if different from above)
Summer Address (if different from above)

City
City if different summer address

State
State if different summer address

Zip Code
Zip Code if different summer address

Are you a resident of Worcester County?
Are you a resident of Worcester County?

2. Specify the Purpose of this Potential Scholarship

Type of School
Type of School

3. Education Background

Are you presently enrolled in a high school or college?
Are you presently enrolled in a high school or college?

Name of school (if presently enrolled)
Name of school (if presently enrolled)

Address of school (if presently enrolled)
Address of school (if presently enrolled)

City
City of school (if presently enrolled)

State
State of school (if presently enrolled)

Zip Code
Zip Code of school (if presently enrolled)

If in college, what is your major?
If in college, what is your major?

If in college, are you attending full or part time
If in college, are you attending full or part time?

4. Education Goals

What school do you plan to use this scholarship for?
What school do you plan to use this scholarship for?

Address of School
Address of School

City
City of School

State
State of School

Zip Code
Zip Code of School

Are you currently enrolled at this school?
Are you currently enrolled at this school?

What is your enrollment date?
What is your enrollment date?

What will your major be?
What will your major be?

What degree/certificate are you seeking?
What degree/certificate are you seeking?

When do you expect to receive your degree?
When do you expect to receive your degree?

Expected Date of Acceptance
NOTE: If you are entering school as a freshman or a transfer student, proof of acceptance must be furnished with your application materials. If you have not been notified of your acceptance as of the date that you are filling out this application, please indicate the date which you expect to receive notice of acceptance from the school.

If Transfering from Post-Secondary School
If you are transferring from one or more post-secondary schools, please indicate below. If more space is needed please list them on a different sheet.

School Address
School Address If Transfering from Post-Secondary School

City
If Transfering from Post-Secondary School

State
State of School If Transfering from Post-Secondary School

Zip Code
Zip Code of School If Transfering from Post-Secondary School

Dates Attended
Dates Attended If Transfering from Post-Secondary School

5. Essay

Essay
Please tell us about yourself. Explain why you have chosen your particular field of study, and briefly discuss your career goals upon graduation.

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