Ohio Child Conservation League Disability Grant Application

Transcription

1 Ohio Child Conservation League Disability Grant Application This grant is given to a student with a physical or learning disability which must be properly documented. A letter from your doctor or a trained school counselor must accompany this application. This grant is up to $2,000 given over four years, with the student receiving up to $500 per year. The number of grants given in any year is based on the funds available to the SLF Committee. In order for a student to continue receiving a disbursement each year he/she must show an aptitude for the chosen course of study, ability, resourcefulness, and good character. The student must also send proof of progress in his/her studies to the State Vice-President by February 1 of each year. This submission will continue his/her eligibility to receive the renewal for the following school year. A student applying for the Disability Scholarship Grant may also apply for an OCCL Student Loan. The applicant should gather all of the required parts of the application and send them at one time. The following is a complete listing of all the documents which should be provided: Three (3) personal reference letters A current transcript with the school's name and information of the school on the transcript Picture of applicant (wallet 2.5 X3.5 ) for publicity purposes (photo paper) Proof of membership in an active OCCL group (League membership number) Essay that addresses these points (a separate and different essay from other OCCL grants and loans): 1. What is your Disability? 2. Having a disability can have both positive and negative effects on your life. How has your disability affected you? 3. Please give us some information on your goals in life and how you plan to obtain them. 4. What are your interests and activities both in and out of school? 5. Please tell us about your family. How may they be of assistance to you? 6. Why do you think the committee should choose you for this Scholarship? The essay must be two (2) pages double-spaced written in 12-point Times New Roman font with 1-inch margins at the top, bottom, and both sides. Put all personal information on the back of the essay. Return this completed application package to: Virginia Rice State Vice President / SLF Chair County Road AC Wauseon, OH vmrice1@centurylink.net revised 09/11 PLB

2 Ohio Child Conservation League Disability Grant Application Please complete all requested information. Print or type the information. If you have any questions about the application please contact the State Vice President. I. PERSONAL INFORMATION Full legal name: Home address: Phone# Cell Phone # Date of Birth: Sex: Marital Status: If you are under the care of a guardian please specify below: Father s Name: Address: Mother's Name: Address: If you are married please complete the following information: Spouse s Name Address: Names and ages of children: Please circle one or more of the following OCCL Memberships (The OCCL member name is required): Grandmother Mother Self Great- Grandmother OCCL Member Name: Name of League and City: District: Numbers of years as an OCCL member: If you have no affiliation, what league will sponsor you for a loan? II. SCHOLASTIC INFORMATION Name of High School you have graduated or will graduate from: Date of Graduation: Month Year Your rank in the graduating class: Cumulative Grade Point Average: Student Status: Full-time Part-time Name of the current principal at your high school: _ Previously attended college or institution of higher learning: Your course of study: _ Cumulative Grade Point Average: I have applied for admission to: (Name of school) _ Please check one: I have been accepted I have not been accepted Year in College (please circle) Address of school: Your intended course of study: How many years of study is this course intended to take? Revised 10/7 PLB

3 Do you already have some credits applicable to your chosen course of study? Yes No If yes, how many years until this course will be completed? What are your reasons for having chosen this course of study? III. REQUEST FOR SPECIFIC AMOUNT OF AID AGREEMENT & CONDITIONS UNDER WHICH SAME WILL BE GIVEN If you receive the OCCL Disability Grant do you want to be considered for the OCCL Loan Program? Yes No If you do not receive the OCCL Disability Grant do you want to be considered for the OCCL Loan Program? Yes No ****If you answered yes to either of the last two questions, please complete the following OCCL Loan Application**** A maximum of $ per year may be granted to the loan applicant over a period of five (5) years. I,, hereby apply for aid and assistance from the Ohio Child Conservation League Loan Fund, in the amount of $ to enable me to continue my studies at, from 20 to 20. I will use all money which I receive from the Ohio Child Conservation League Loan Fund for the purpose of completing my education and for no other purpose whatsoever. I will repay this money one year from the date I graduate or leave school in the event that I should not complete my education. My course is a year course and upon completion of my education I plan to (Example, teach, practice medicine, etc.) If this loan is granted I will sign a note for the amount of the loan. This note will be co-signed by, who is my. (The Ohio Child Conservation League requires a co-signer even though the Applicant may be of legal age.) Signed: Dated: Revised 9/11 PLB

4 For Committee Use Only: Yes No Application received by Feb. 1 References received Copy of transcript received Picture of student received Essay received Committee Action: We, the undersigned Committee members of the Ohio Child Conservation League Scholarship Loan Fund, hereby (APPROVE-DISAPPROVE) this application and direct that said money be paid to the applicant in the amount of $. Dated: Account Number: Due Date: Revised 09/11 PLB

5 The Ohio Child Conservation League Disability Grant Reference Form Applicant s Name: Address: _ This student has applied for this grant to further his/her education. Please be kind enough to give us the information indicated, and any additional information which may aid us in our decision concerning this application. After completing this form, place in an envelope and return to student to be submitted with the completed application as all materials need to be mailed together. We thank you for your cooperation in this matter. Sincerely, Virginia Rice, State Vice President / SLF Chair 1. How long, how well, and in what capacity have you known the applicant? 2. What do you know of the applicant s scholastic and extra-curricular achievements? 3. Please evaluate the applicant s personal characteristics such as honesty, integrity, reliability, willingness to work, etc. Signed Occupation Phone No. ( ) (Use the back for any additional comments you may choose to make) Revised 9/11 PLB