Full Name : Date of Birth: Email: Home Address: City: State: Zip Code: Home Phone: Institution Attended in the Spring of 2010, Class Standing, and Cumulative GPA: Institution to be Attended in the Fall of 2010 Major/Academic Goal:
If living on campus, please fill out the information below:
I agree and understand that by checking this box and clicking the Submit button I am only submiting the scholarship application. I still need to submit to the state office my supporting documentation. I understand that my transcript(s) and documentation must be submitted to the state office no later than September 1st, 2010. Please mall all documentation to the address below: National Federation of the Blind of California Attn: Mary Willows, President 39481 Gallaudet Drive #127 Fremont, CA 94538 (510) 248-0100 (877) 558-6524
