KCB Educational Scholarship Application Form

Kentucky Council of the Blind Educational ScholarshipApplication Form

Please complete this application and email all requested documentation to grants@kentucky-acb.org. If you have questions after reading the KCB Scholarship Guidelines or if you need assistance completing this application, please email a description of your questions and needs and a telephone number where you can be reached to this email address.

 

The deadline for this application and all supporting materials is September 15 at 11:59 PM Eastern time; applications and supporting materials received after this date will not be considered.

 

Supporting Documentation

Please use the following links to download supporting documentation.

Please complete this form to start the application process or download a copy above.

Kentucky Council of the Blind Educational Scholarship Application

Kentucky Council of the Blind Educational Scholarship Application form

Please complete this application and email the application and all requested documentation to grants@kentucky-acb.org. If you have questions after reading the KCB Scholarship Guidelines or if you need assistance completing this application, please email a description of your questions and needs and a telephone number where you can be reached to this email address.

The deadline for this application and all supporting materials is September 15 at 11:59 PM Eastern time; applications and supporting materials received after this date will not be considered.

Personal Information

Applicant's Name
Street Address
Summer Address, if Different from Above:
Home
Cell:
Attendance at KCB State Convention
Are you able to participate in the Kentucky Council of the Blind Conference and Convention held during November
Are you a member of KCB?
Have you been awarded a KCB Educational Scholarship prior to this application?
MM slash DD slash YYYY

EDUCATIONAL BACKGROUND

Address
Please enter a number less than or equal to 4.
I am currently pursuing:
Date degree expected:
If you are entering this school as a first-year student or transfer student, proof of acceptance must be included with your application materials. If you have not been notified of your acceptance, please indicate the date on which you expect to receive notice from the school.

List other secondary or post-secondary schools you attended

Address
Please enter a number less than or equal to 4.
Dates Attended: Beginning
Dates Attended: Ending
Address
Please enter a number from 0 to 4.
Dates Attended: Beginning Date
Dates Attended: Ending Date
Address
Please enter a number from 0 to 4.
Dates Attended: Beginning Date
Dates Attended: Ending Date

WORK EXPERIENCE

List all full- or part-time work experience. Include the employer's name, date(s) employed, duties, and whether this was summer employment or during the school year.
Date: Beginning Date
Date: Ending Date
Employment occurred:
Date: Beginning Date
Date: Ending Date
Employment Occured:
MM slash DD slash YYYY
Date: Ending Date
Employment occurred:

EXTRACURRICULAR ACTIVITIES

List all major outside activities (school, religious, community, sports, organizations of the blind, etc.) Include the extent to which you have played a leadership role.
Statement of Agreement
Signature of Applicant
Type first and last name signifies you agree and is considered a valid signature.
MM slash DD slash YYYY
Enter today's date.

Email supporting documents to: grants@kentucky-acb.org.

Kentucky Council of the Blind

Educational Scholarship Program

148 Vernon Avenue

Louisville, KY 40206

Phone: (502) 895-4598Email: grants@kentucky-acb.org.

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