Eligability: Students must meet these criteria to be eligable. Please check to confirm.

1.I confirm that I am legally blind in both eyes

2.I live in the United States or Puerto Rico.

3.I will be attending a college in the united states or Puerto Rico in the fall of 2012.

4.If chosen for a scholarship i will attend the full 3 days of the NFBI anual convention in April 2012

Information:

First Name:

Middle Name:

Last Name:

Prefered Name:

Date of Birth:

Email:

What is your home address?

Address line 1:

Address line 2:

City:

State:

Zip code:

Telephone

Home Phone #:

Cell Phone #:

Have you won a NFB Scholarship before?

Yes
No

If yes, State or National? and what year?

Education:

What school do you presently attend?

Name:

Address:

City:

State:

Zip Code:

What is your current GPA?

(Required for High School Students only) What was your college admission composite test score(s)?

ACT:SAT:Other:

What college will you be attending in the 2012-2013 school year?

Name:

City:

State:

If undecide list name, city, state of colleges under consideration.

Colleges under consideration:

Classification in fall semester 2012?

Freshman
Sophomore
Junior
Senior
Graduate Student

What degree(s)/marjor(s) are you pursuing?

What profession or field of employment do you wish to enter with your college degree?

anticipated year of college graduation?

list name, city, and state of any other postsecondary institutions you have attended:

Certification Statement

By checking the box below, I certify and confirm that all information provided above and in acompanying documents is true and correct to the best of my knowledge.

I confirmDate:

Your application is not complete untill you have submitted all required documentation. The documentation that still needs to be submited can be found in the list below. All documents must be submited by March, 23 2012

1. Two letters of recomendation
2. Transcrips are required
3. Reports on college entrance examinations are required. (high school students only)
4. Proof of legal blindness (in both eyes) is required
5. The Essay: What does the committee need to know about you in 700 words or less? The commitee members are especialy intrested in your most notable qualities, your attitude about blindness, and examples of your demonstrated leadership ability. Recommended font is 12pt arail. Essays are limited to No More Than 700 Words.

Please submite all of the above documents to:

Vickie Bateman

NFBI Scholarship Committee Chair

760 Aspen ave. Shelly, ID 83274

Phone: 1-(208)-357-7403 or 1-(208)-709-1311

Fax: 1-(208)-3577403

Email: vickiebateman@cableone.net