CCLVI Fred Scheigert Scholarship Application
 
INSTRUCTIONS

Complete all sections of this application
Narrative/essay responses may be submitted on a separate 
sheet of paper.  Only applications prepared in at least 14 
pt. boldface print will be accepted.  Attach certified copy 
of transcript from school most recently attended.  
Attach TWO (2) letters only of recommendation or reference.
DO NOT submit materials which are not requested.  You MUST 
include a letter of acceptance from your new school, if you
are not returning to the school you currently attend. 
NOTE: This is a publicized award.


I. PERSONAL DATA

Name                                           Home Phone                           
Address                                                                                                    
                                                                                                                  
Male            Female         			S.S. #                                          
Date of Birth                      
Name and location (City and State of high school attended
                                                                                                                  
                                                                                                                  

II. Visual Status
Have your eye care professional complete the Scholarship 
Applicants’ Eye Report Form included in this packet.  Attach 
this completed form.

List all of the devices you use to read and to perform other 
“visual” tasks daily.









Check all the methods that you use for reading.
         Live reader				Braille
         Regular Print				Large Print
         Recordings				Computer 
         Closed Circuit Television System
         Scanner or other Optical Character Recognition Device
         Other- Please describe


	  With glasses on, or through a low vision device, 
	  are you able to read ordinary newspaper print?                                               

III.	Academic Goals
List the field or course of study you are pursuing, and 
explain why you have chosen it.





       Freshman         Undergraduate        Graduate


School in which you are currently enrolled

               Name:                                                            
		Address:                                                                    
		Your Status          Full time            Part time  
		Usual semester/quarter hour load               
		Major(s)                                                                
		Degree Sought                                                      
	   	
	   	School you plan to attend next fall if 
	        different.  
		Name:                                                           
		Address:                                                                        
		Major(s)                                                                        
		Degree Sought                                                        
	   	
	   	List other graduate/undergraduate schools 
	        attended.  
		(Provide name, address, major, GPA, and degrees)

IV	Essay
In an essay of NO MORE than two double spaced pages, tell 
us more about yourself.  DO NOT repeat information already 
provided in this application.  Discuss your work experience, 
extra curricular activities that you are involved in, 
including school, church, and community, and describe 
leadership positions you have held.  List any awards, honors, 
or citations received.  In addition, it is essential that 
you tell us how you plan to use these scholarship monies.  



Return this application with the required postage no later than 
this coming April 15, to:
		Bernice Kandarian 
		2211 Latham Street, #120 
		Mountain View, CA 94040-1652 
		(800) 733-2258
		E-mail: bernice@tsoft.net