[Scholarship-comm] Tech Grant Application - Tonya Johnson

[Matt Selm]

-------- Forwarded Message --------
Subject: 	Your Google Form: New respondent (#3)
Date: 	Thu, 26 Sep 2019 21:55:54 +0000
From: 	mpselm at gmail.com
To: 	mpselm at gmail.com



*Your Google Form* 
<https://docs.google.com/forms/d/e/1FAIpQLSdvqr7f8oEv9MMhFK60fE0Rrma_Isv3euDhcCRHlgluiPasKg/viewform> 
has received a new response:

Applicants' Name *Tonya Johnson *
Street Address *7478 Sulphur Rd*
City *Sulphur*
State *Kentucky*
Zip *40070*
Phone *8123446000*
E-mail *johnsontonyaj at gmail.com*
Are you able to attend the KCB State Convention from November 15-16 2019 
in Louisville KY? *Yes*
If the answer is no, why not? **
Are you a member of the Kentucky Council of the Blind? *Yes*
If applicable, list KCB chapters to which you belong: **
Have you previously received a KCB Assistive Technology grant? *No*
If yes, please list date of award: **
What is the grant amount you are requesting? *Please note that the 
maximum amount to be awarded for 2019 will not exceed $500. *$500*
Are you able to pay for any portion of the item? Please list other 
sources of funds, such as personal funds, loans, other grants (including 
from whom): *Private personal funding for the rest. *
Why are you applying for this grant? *I need a couple of very expensive 
items as my eyesight gets worse. I’m trying to find ways to take the 
financial pressure off of those who are helping me buy the equipment. *
Describe the assistive technology to be purchased: *QBraille it is a 40 
cell braille display with a QWERTY keyboard *
What are the exact specifications of the item to be purchased? *40 cell 
Braille display with function keys for ease of use and ease of commands. *
Please provide your two (2) vendor quotes. If only one (1) quote is 
available, please provide that information. Please include links if 
possible to the product page of the vendor. *I was only able to find 
this product at HIMS.*
Do you agree with the "Statement of Agreement" above? *Yes, I agree*
Electronic Signature of Applicant: *Tonya Johnson*
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