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SCHOLARSHIP PROGRAM 2010 APPLICATION FORM

Online Edition

Procedure: An e-mail address is required to use this online form. You may change your answers as often as you wish until you press the Submit button at the end. After pressing it, your completed form automatically will be sent to our database, a copy will be sent to your e-mail address (question 10), and you will receive a confirmation e-mail. Do contact us if you do not receive these e-mails.

Questions? Call (410) 659-9314 (8 a.m. – 5 p.m. weekdays) or e-mail: scholarships@nfb.org. Web site: www.nfb.org/scholarships -- To complete your application, read the "Scholarships Submissions Checklist" and mail the other required documents to: NFB Scholarship Program, 200 East Wells Street, Baltimore, MD 21230. All application documents must arrive in our office postmarked no later than March 31, 2010.

*Required field(s) are indicated by an .**
Eligibility: Students must meet these criteria to be eligible. Please check the box to confirm.
* 1. I confirm that I am legally blind in both eyes.
* 2. I live in the United States (includes Washington, DC, and Puerto Rico).
* 3. I will be attending a college in the United States in the fall of 2010.
* 4. If chosen for a scholarship, I will attend the full week of the NFB annual convention, July 3-8, 2010.
5. Name
* First name
Middle name
* Last name
If it is different than your formal name, what do you prefer to be called?
I prefer:
6. Have you won an NFB scholarship on the national level before?
* Won:	Yes
	No
If yes, in what year?
Year
7. Home Address: The NFB Scholarship Program is restricted to residents of the 50 states of the United States of America, District of Columbia, and Puerto Rico.
* Address
Address 2
* City
* State	* Zip code
8. Primary telephone:
* Phone #	area code first, xxx-xxx-xxxx
9. Secondary phone:
Alt Phone #	area code first, xxx-xxx-xxxx
Extension
10. E-mail:
* E-mail
11. DOB:
* Date of birth	/ / (MM/DD/YYYY)
12. What school do you currently attend?
* School Name
* City
* State	* Zip code
* School phone
10. State your major(s):
* What is your current GPA?
13. Required for high school students only—college admission composite test scores. Mail photocopies of all score reports with other required documents.
ACT
SAT
Other
14. What college will you attend in 2010-2011? (If undecided at present, send the school's name, city, and state to us before March 31, 2010.)
School name
City
State
14b. If undecided, please list colleges under consideration with city and state:
College name(s)
15. Classification in fall semester 2010:
* Class	(freshman, sophomore, etc.)
16. What degree(s) are you pursuing?
* Major(s)
17. What profession or field of employment do you wish to enter with your college degree?
* Field
18. Anticipated year of college graduation:
* Year
19. List any other postsecondary institutions you have attended:
Name
City
State	Years

Name
City
State	Years

Name
City
State	Years
20. The Essay: What does the scholarship committee need to know about you in 1,000 words or less? The committee members will be especially interested in these points: your most notable qualities, your attitude about blindness, and examples of your demonstrated leadership ability. Your essay is limited to no more than 1,000 words, (approximately two print pages or 6,000 characters). Well-done, short essays are admired.
* Essay text
21. Certification Statement By checking this box, I confirm that all of the information provided above and in the accompanying documents is true and correct to the best of my knowledge.
* I confirm