The Anne Ford Scholarship

Transcription

1 Application is seeking applicants for the Anne Ford Scholarship. The Anne Ford Scholarship is a $10,000 ($2,500/year over four years) award granted to a graduating high school senior with a documented learning disability who will be enrolled, in the fall of 2016, in a full-time bachelor s degree program. The ideal Anne Ford Scholar is a student who: Articulates his/her LD and clearly demonstrates the importance of self-advocacy Is committed to completing a four-year college degree and has begun to set realistic career goals Participates in school and community activities Has demonstrated academic achievements consistent with college and career goals Plans to contribute to society in ways that increase opportunities for individuals with LD Excels as a role model and spokesperson for others who struggle with LD Demonstrates financial need Eligibility & Selection Criteria To be eligible for the Anne Ford Scholarship, an applicant must: Have an overall Grade Point (GPA) of 3.0 or higher on a 4 point scale (or equivalent) Demonstrate financial need Provide most current documentation of an identified learning disability Please note: ADD/ADHD alone is not considered a learning disability; eligible candidates must also provide documentation of a specific learning disability. Be a US Citizen Please note: If you will be attending a two-year community college, vocational or technical training program, or specialized program for students with LD, you are not eligible to apply for the Anne Ford Scholarship. Please visit our website at for more information on the Allegra Ford Thomas Scholarship. I learn differently than everyone else but I do not allow that to limit how much I am able to learn. - Macy Olivas, 2009 Anne Ford Scholar

2 M entoring & Outreach Opportunities The Anne Ford Scholar must be willing to mentor future Scholars and act as a role model for individuals with learning disabilities through such activities as public speaking, writing for publications, and engaging in other opportunities made possible through NCLD. Selection Process The Anne Ford Scholarship Committee, comprised of members of NCLD s Board of Directors, Professional Advisory Board, and distinguished friends, will make the final selection of scholars in Spring Scholarship Requirements Anne Ford Scholars are required to submit annual updates detailing their progress in school and offering insights about their academic and personal growth. The $10,000 scholarship will be paid in four yearly installments of $2,500. Scholars must provide proof of course registration to receive their first installment. To continue receiving payments, scholars must provide proof of course registration for each ensuing semester and documentation of passing grades (transcripts). Submitting Your Application Use the Application Requirements Checklist to make sure that all needed materials are included in the scholarship packet. All required materials must be received in one packet to be considered for the scholarship. Complete packets only should be mailed to: National Center for Learning Disabilities c/o Anne Ford Scholarship 32 Laight St., 2nd Floor New York, NY Complete application packets MUST be postmarked by December 15, Please note that any materials submitted as part of the application process will not be returned.

3 Application Requirements Checklist The Anne Ford Scholarship is for graduating high school seniors who will be attending a four-year, bachelor s degree program in the fall. If you are planning to attend community college, vocational or technical school, or a specialized program for students with LD, please visit us at to apply for the Allegra Ford Thomas Scholarship. Use this checklist to keep track items needed for the Anne Ford Scholarship application. Please be sure you include the following materials in your packet: Basic Information Form Personal Achievements & Activities Form A personal statement (see Personal Statement page for details) High school transcript (official or unofficial) Three (3) letters of recommendation Financial Statement Form Submit all of these materials in one packet to: SAT, ACT, or other standardized test scores (unofficial copies acceptable) Most recent documentation of a learning disability National Center for Learning Disabilities c/o Anne Ford Scholarship 32 Laight St., 2nd Floor New York, NY 10013

4 Basic Information Form Pag e 1 of 3 APPLICANT INFORMATION (You may type in your answers and print the form. If you choose to handwrite, please write legibly.) Applicant Name: Last First Middle Date of Birth: Check One: Male Female Month / Day / Year Mailing Address: City: State: Zip Code: Home Phone: Cell Phone: Are you a US citizen?* Yes No * Applicants must be current US citizens. If you have questions about your eligibility for this award, send your inquiry to AFScholarship@ncld.org PARENT/GUARDIAN INFORMATION Parent/Guardian Name(s): Mailing Address (if different than above) : City: State: Zip Code: Check all that apply: Parent Other relative (specify): Legal Guardian Other (specify): Home Phone (if different than above) : Cell Phone: I would like to subscribe to NCLD newsletters, updates and alerts. Yes No

5 Basic Information Form Pag e 2 of 3 SCHOOL HISTORY High School(s): Name of School City/State Years Attended Middle School(s): Name of School City/State Years Attended Primary/Elementary School(s): Name of School City/State Years Attended How did you learn about the Anne Ford Scholarship? Family School Website (please specify): Other (please explain):

6 Basic Information Form Pag e 3 of 3 LEARNING DISABILITY INFORMATION Please check which of these learning disabilities you have (check all that apply): Basic Reading (Dyslexia) Math Calculation (Dyscalculia) Reading Fluency (Dyslexia) Math Problem Solving (Dyscalculia) Spelling Executive Functioning/Organization Reading Comprehension (Dyslexia) Non-verbal LD Listening Comprehension (and processing) Other: Written Expression (Dysgraphia) Date of initial diagnosis/classification: Date of most recent testing: OPTIONAL SELF-IDENTIFICATION African-American/Black (not of Hispanic origin) Asian or Pacific Islander (includes Indian subcontinent) American Indian or Alaskan Native Hispanic/Latino (Spanish culture or origin, regardless of race) White (persons of not Hispanic origin, having origin in any of the original peoples of Europe, North Africa or the Middle East) Race not included above (please specify): CERTIFICATION AND AUTHORIZATION Certification: All of the information provided on this form is true and complete to the best of my knowledge. I certify that I have a documented learning disability, will be earning my high school diploma or its equivalent, and will be enrolling for the first time in a community college, vocational or technical training program, or specialized program for students with LD in the academic year. I hereby authorize the National Center for Learning Disabilities (NCLD) to use excerpts from my essay along with non-financial information from my application for publicity and public relation purposes, provided that my confidentiality is protected. I understand that information contained in my essay may be used for research and/or publictiy related activities. All application materials including essays and transcripts become property of NCLD. Authorization for Release of Information/Records: Applicants are responsible to arrange for transcripts and other required documentations to be submitted to NCLD. IN the event that NCLD finds it necessary to seek additional information, permission is hereby given to NCLD and its designees to contact school officials and others to request additional relevant information for use by the Anne Ford Scholarship Selection Committee and/or NCLD staff. Signature of Applicant: Signature of Parent/Guardian: (required if applicant is under 18) Date: Date:

7 Personal Achievements and Activities Form Pag e 1 of 3 Name: Last First Middle PART 1: ACADEMIC INFORMATION Grades: You MUST sumbit a copy of your transcript. Grade Point (GPA): Class Rank (if available): out of Standardized Testing: As an option, you may submit either SAT or ACT scores (not required). SAT Exam Date: / / Best Score: ACT Exam Date: / / Best Score: Math Critical Reading Writing Composite Are you planning to take either test again? Yes No If you have taken any other standardized tests (AP, IB, SAT Subject, etc.) and would like to share your scores, please do so below:

8 Personal Achievements and Activities Form Pag e 2 of 3 PART 1: EXTRACURRICULAR ACTIVITIES Use this section to list extracurricular activities (school clubs, sports, etc.) you have been involved in. If you need more room, attach a second page. Activity Grades Involved Check all that apply Hours per Week or Check all that apply Position Held, Awards/Honors, Other Achievements PART 2: COMMUNITY AND WORK EXPERIENCE Use this section to list any community, volunteer, or work experience you have. If you need more room, you may attach a second page. Activity Grades Involved Check all that apply Hours per Week or Check all that apply Position Held, Awards/Honors, Other Achievements

9 Personal Achievements and Activities Form Pag e 3 of 3 PART 3: OTHER ACTIVITIES Use this section to list any other activities you have been involved in. If you need more room, attach a separate page. Activity Grades Involved Check all that apply Hours per Week or Check all that apply Position Held, Awards/Honors, Other Achievements PART 4: SPECIAL INTERESTS AND HONORS & AWARDS Do you have any additional special interests or hobbies? If so, explain below: Since the 9th grade, have you received any special awards or honors? If so, list below: Feel free to include any additional information or a resume as part of this application.

10 Personal Statement Please pay special attention to this part of the application. Together with information provided in letters of recommendation, the personal statement is the best way for members of the review committee to get to know you and understand your journey as a student with LD. This personal statement should describe your frustrations and triumphs in dealing with your specific learning disability. Feel free to express yourself in creative ways! Be sure that you share how you embody the characteristics of an ideal candidate as described in the introduction to the application. Your statement should make specific mention of how you believe a college education will enhance your life and how the Anne Ford Scholarship will help you achieve this goal. Submit your personal statement as a written essay of words. If President Obama wants to shore up this nation s pool of scientists and inventors, if Steve Jobs wants ideas of how to unleash creativity, and superpower countries want to move toward that next big idea, there is an army of tens of thousands of LD students like myself ready and willing to show how it is done. - Mackenzie Meyer, 2009 Anne Ford Scholar

11 Recommendation Form Pag e 1 of 2 All applications must be postmarked by December 15, Please return this form and any additional documentation to the student so it can be included in the completed application packet. Name of Applicant: Applicant Date of Birth: / / The Anne Ford Scholarship is a $10,000 scholarship given to a high school senior with a documented earning disability who will be enrolled in a full time bachelor s degree program in the fall. The Ideal Anne Ford Scholar is a student who: Has faced the challenges of having a learning disability with perseverance Is committed to completing a college degree and setting career goals Embraces new opportunities Has a well-rounded perspective shaped by experiences at school and in the community Understands how LD affects his or her life and recognizes the importance of self-advocacy Believes in contributing to society in ways that increase the potential of all people with LD Would welcome opportunities to serve as a role model and spokesperson for others with LD INSTRUCTIONS Step 1: Please provide the following information about yourself Name: Title: School/Organization: City: State: Zip Code: Mailing Address: Telephone: ( ) - Ext.: How do you know the applicant? How long have you known the applicant?

12 Recommendation Form Pag e 2 of 2 Step 2: Please complete the rating scale below Below Above Well Above Outstanding I Don t Know Academic Achievement College Readiness Perseverance Motivation Self-advocacy Understanding of LD Leadership and Initiative Involvement in school/ community actvities Role model/spokesperson for people with LD Use of accommodations and supports Step 3: Please answer the following questions on a separate piece of paper. 1. Is this student an effective self-advocate? Explain. 2. How has this student reacted to setbacks or persevered in difficult situations? Please give examples if possible. 3. How well does this student understand his/her LD? Explain. 4. What are the three characteristics you most appreciate about this student? Feel free to provide additional feedback about this student in your response. Please return this form and completed additional pages to the student.

13 Recommendation Form Pag e 1 of 2 All applications must be postmarked by December 15, Please return this form and any additional documentation to the student so it can be included in the completed application packet. Name of Applicant: Applicant Date of Birth: / / The Anne Ford Scholarship is a $10,000 scholarship given to a high school senior with a documented earning disability who will be enrolled in a full time bachelor s degree program in the fall. The Ideal Anne Ford Scholar is a student who: Has faced the challenges of having a learning disability with perseverance Is committed to completing a college degree and setting career goals Embraces new opportunities Has a well-rounded perspective shaped by experiences at school and in the community Understands how LD affects his or her life and recognizes the importance of self-advocacy Believes in contributing to society in ways that increase the potential of all people with LD Would welcome opportunities to serve as a role model and spokesperson for others with LD INSTRUCTIONS Step 1: Please provide the following information about yourself Name: Title: School/Organization: City: State: Zip Code: Mailing Address: Telephone: ( ) - Ext.: How do you know the applicant? How long have you known the applicant?

14 Recommendation Form Pag e 2 of 2 Step 2: Please complete the rating scale below Below Above Well Above Outstanding I Don t Know Academic Achievement College Readiness Perseverance Motivation Self-advocacy Understanding of LD Leadership and Initiative Involvement in school/ community actvities Role model/spokesperson for people with LD Use of accommodations and supports Step 3: Please answer the following questions on a separate piece of paper. 1. Is this student an effective self-advocate? Explain. 2. How has this student reacted to setbacks or persevered in difficult situations? Please give examples if possible. 3. How well does this student understand his/her LD? Explain. 4. What are the three characteristics you most appreciate about this student? Feel free to provide additional feedback about this student in your response. Please return this form and completed additional pages to the student.

15 Recommendation Form Pag e 1 of 2 All applications must be postmarked by December 15, Please return this form and any additional documentation to the student so it can be included in the completed application packet. Name of Applicant: Applicant Date of Birth: / / The Anne Ford Scholarship is a $10,000 scholarship given to a high school senior with a documented earning disability who will be enrolled in a full time bachelor s degree program in the fall. The Ideal Anne Ford Scholar is a student who: Has faced the challenges of having a learning disability with perseverance Is committed to completing a college degree and setting career goals Embraces new opportunities Has a well-rounded perspective shaped by experiences at school and in the community Understands how LD affects his or her life and recognizes the importance of self-advocacy Believes in contributing to society in ways that increase the potential of all people with LD Would welcome opportunities to serve as a role model and spokesperson for others with LD INSTRUCTIONS Step 1: Please provide the following information about yourself Name: Title: School/Organization: City: State: Zip Code: Mailing Address: Telephone: ( ) - Ext.: How do you know the applicant? How long have you known the applicant?

16 Recommendation Form Pag e 2 of 2 Step 2: Please complete the rating scale below Below Above Well Above Outstanding I Don t Know Academic Achievement College Readiness Perseverance Motivation Self-advocacy Understanding of LD Leadership and Initiative Involvement in school/ community actvities Role model/spokesperson for people with LD Use of accommodations and supports Step 3: Please answer the following questions on a separate piece of paper. 1. Is this student an effective self-advocate? Explain. 2. How has this student reacted to setbacks or persevered in difficult situations? Please give examples if possible. 3. How well does this student understand his/her LD? Explain. 4. What are the three characteristics you most appreciate about this student? Feel free to provide additional feedback about this student in your response. Please return this form and completed additional pages to the student.

17 Financial Statement To be filled out by the student s legal parent/guardian. Completed application packet must be postmarked no later than December 15, Name of Applicant: Applicant Date of Birth: / / STATEMENT OF INCOME Please select an option below Option 1: OR Option 2: Total income as reported on household s Individual income reported by: (applicant and parent/guardian) most recent Parent 1: $ federal income tax return: Parent 2: $ $ Student: $ (IRS Form 1040, Line 7) Other: $ Total Number of exemptions claimed: List all members of the household, ages and relationship to the applicant: Name Age Relationship Name Age Relationship Is this a single parent family? Yes No Number of dependent children in family: Number of dependent children currently attending college: Planned year(s) of graduation: Number of dependent children currently attending high school: Planned year(s) of graduation: COLLEGE/POST-SECONDARY PROGRAM INFORMATION Name of college/program to which applicant applied Accepted? (Check one) Expected Tuition Costs Yes Yes Yes Yes Yes Pending Pending Pending Pending Pending Those candidates chosen for final review by the Selection Committee will be asked to submit most recent copies of federal income tax returns and W-2 forms. Please attach any additional information that you would like to share regarding your financial situation.