Published Quarterly By


An Affiliate of the American Council of the Blind



KABVI strives to increase the independence, opportunity, and quality of life for all blind and visually impaired Kansans, and to assist us in taking our rightful place as equals among our sighted peers.



Volume 55                                                    Spring 2012                                                             No. 1




Corporate Office, 603 SW Topeka Blvd., Suite 304 B

Topeka, Kansas 66603

Telephone:  785-235-8990 or,

In Kansas only, 1-800-799-1499

E-mail:  kabvi@att.net 

Web sites:  www.kabvi.com and www.kabviyouthconnection.com 


Editor,                                                                                    Associate Editor,

Nancy Johnson                                                                  Ann Byington

714 SW Wayne Ave.                                                           909 SW College Ave.

Topeka, KS 66606                                                              Topeka, KS  66606

(785) 234-8449                                                                     (785) 233-3839

Supermom1941@sbcglobal.net                                    abyington@cox.net


Chairman of the Board and President

Ann Byington

909 SW College Avenue

Topeka, KS 66606

(785) 233-3839




Membership Secretary, KABVI


         The purpose of KABVI NEWS, published by the Kansas Association for the Blind and Visually Impaired, Inc. (KABVI), is to promote the general welfare of the blind and visually impaired in Kansas.  KABVI NEWS shall reflect the philosophy and policies of the Association, report the activities of its members, and include pertinent articles pertaining to blindness and low vision. 
         Publication Policy:  Send us your news, views, articles, and features.  Materials in braille, on tape, on computer disk (Microsoft Word, plain text, or ASCII), or typewritten (double-spaced) will be considered.   When quoting from other published materials, please include dates and sources.  Unsigned material will not be considered for publication.  If you send a stamped, self-addressed envelope, original materials will be returned.  Articles for publication must reach the editor by January 22, April 22, July 22, and October 22 of each year.  Editorial staff reserves the right to edit submitted materials. 
         Membership renewal letters are sent annually to persons who have not paid dues.  If responses are not received within a reasonable time, names of those persons will be removed from KABVI’s mailing list and their subscription to KABVI NEWS discontinued.  Membership is open to anyone who is interested, but is not required for receipt of KABVI NEWS.  A membership renewal form on which you can indicate your newsletter preferences can be found at the end of each issue.  Thank you for your cooperation.





Table of Contents

Kansas Advisory Committee for the Blind and Visually Impaired Meeting Report,

by Ann Byington

Notions, by Nancy Johnson, Recording Secretary

How to Participate in the State Wide Conference Calls, 7:00 PM CST,

Third Thursday Each Month

Report from the Board of Directors, by Nancy Johnson, Recording Secretary

How Does Work Affect My Check Benefits

Tantalizing Tidbits, compiled by Nancy Johnson

In Memoriam, compiled by Nancy Johnson

Directors, 2012

2012 KABVI Membership Application

Esther V. Taylor Scholarship Supplemental Sheet

Esther V. Taylor Scholarship Application Form


Kansas Advisory Committee for the Blind and Visually Impaired Meeting Report

By Ann Byington


The KS Advisory Committee for the Blind and Visually Impaired (KACBVI) met on January 5th.  Following introductions/welcome by Madeleine Burkindine, Committee co-Chair, Mike Donnelly, KS Rehabilitation Services (KRS) Director, reported statistics on the Older Blind Program.  KABVI members will recall that this is what used to be the Kan-SAIL program and now is handled through contractual arrangements with Envision, Wichita; Alphapointe, KS City, Mo.; and Prairie Independent Living Resource Center Partnerships.  The report stated:

 “Older Blind Independent Living (OIB) Services

449 consumers received OIB services in FY 2011.

Alphapointe served 102 consumers; Envision served 228 consumers; and the Prairie Independent Living Resource Center (PILR) partnership served 119 consumers.

In addition, a total of 887consumers, family members, staff and community providers attended 38 outreach activities conducted throughout the state to learn more about services to support independent living for older blind Kansans.

            Of the 449 consumers receiving direct services, the majority were female, white and residents of private homes.  The age group of persons 80 to 89 years old had the most consumers with a total of 171.

The average cost per person receiving OIB direct services in FY 2011 was $1,018.

The most frequently used OIB services were provision of assistive technology (AT) devices with 61% of consumers using this service.  Fifty-two percent of consumers received daily living services.  (We later learned that this category included orientation and mobility services/training.)  Thirty-nine percent of consumers received AT (assistive technology) services and training.

The top referral sources statewide were eye care providers with 36% of the referrals, other with 20% of the referrals, senior programs with 10% of the referrals, and family/friends 9% of the referrals.

Alphapointe served consumers in 6 counties.  Envision served consumers in 10 counties.  PILR Partnership served consumers in 31 counties.

Of the persons receiving OIB services through community-based contractors, 96% received a functional gain as a result of services or are still receiving services to reach a functional gain.

Capacity Building:  The PILR Partnership created a curriculum to increase the capacity of Centers for Independent Living to more effectively serve persons who are blind or visually impaired.  This was presented at the 2011 Disability Caucus.  The manual for this training can be found at http://www.ikanliveindependently.com.

The PILR Partnership has dedicated four staff to becoming certified Orientation and Mobility Specialists.  One person will obtain certification in March, one in August, and two in December.

The PILR Partnership has also dedicated four staff to becoming certified in Braille instruction.  One person will obtain certification in September, two by December, and one by June 2013.”

Madeleine Burkindine and Chris Owens were re-elected to serve as co-chairs for one more year. The Annual Report Committee was thanked for its work toward submitting this document to the Governor.

The remaining discussion focused on the continuing reorganization of Social and Rehabilitation Services (SRS), including the recent resignation of Secretary Rob Siedlecki. 

House Bill 2442 was also discussed as the Governor’s Office’s attempt to increase employment of persons with disabilities within the coming year.  The goal is to employ one thousand persons during the year in certified businesses, with 20% of the business workforce being disabled. Contract bidders would receive a 10% credit if they either employed persons with disabilities or purchased products from such certified businesses.

The next meeting of KACBVI is scheduled for early May.



By Nancy Johnson


Some distractions simply must be shared!  They explain why concentration is sometimes difficult.  My five-pound Yorkshire terrier, Sidney, has learned to climb into my lap.  He hops onto the footstool I keep under my desk and climbs up my leg to my lap.  He will do it several times in succession, so putting him down doesn’t stop the distraction.  This time I set him on the desk, and he played hide and seek with me, moving behind the monitor from one side to the other.  And here he comes up my leg again! 

I completed my Master’s degree in education with emphasis on adult education and training January 16.  I hope KABVI will expand into the area of public education.  I believe people can do much to prevent or lessen vision impairment and thus the need for treatment beyond routine examinations.  But we have a considerable amount of work to be done before we can expand into that arena. 

This organization MUST work on fund raising if it wishes to continue what it now does; it must document exactly what it does.  KABVI is a small nonprofit organization of volunteers.  One way to document our work is by tracking the number of hours we spend and identifying the projects we do for the benefit of KABVI.  I know, for example, that the technology committee tracks their time.  I’m tracking the time I spend in the office.  I have trouble documenting the time I spend on KABVI News because of distractions, but I’ve estimated 20-30 hours per quarter.  The youth activities committee meets an hour to an hour and a half each month, which can add up to as much as nine hours of volunteer time each month because six members are on the committee. 

Another advantage of tracking volunteer time is that we will be able to see more clearly what’s going on across the state. Knowing where your interests lie could possibly help us develop some fund raising projects. 

We need information like this when we write grant proposals.  If you have a committee meeting, if you develop a project – whatever you do for KABVI – tell me about it and please let me know how much time you put into it.  I think we’ll be amazed by the work people do, and pulling it all together will give us information we can use when we need data.  Let’s try.  If you have e-mail, send your hours to KABVI with a subject of “volunteer hours” and I’ll see if I can pull them all together.  Include a statement of what you were working on.  Use the toll free phone number and call me with your hours.  I’m spending several hours a week in the office, and we have one additional person who may be able to help there. 

Also, we have a large print brochure that outlines who we are, what we have done, and what we are doing.  We will be glad to provide copies so you can share.  Let’s pull together and move this organization forward.


How to Participate in the State Wide Conference Calls

7:00 PM CST, Third Thursday Each Month


Note:              You are responsible for your normal long distance fees from your existing long distance provider. 

Your Conference Telephone Number(712) 432-6100

Participant Pass code:  126083# (pound sign key on your telephone)

How to Join the Conference:

1.      Dial 1-(712) 432-6100 and

2.      Enter the Pass Code 126083 followed by # (pound sign key).

If the conference is not in session, the system will put you on hold until the moderator arrives.

During the Conference - Conference Commands:

Press *3 – Exit Conference

Press *4 – Help Menu

Press *6 – Mute Individual Line


Report from the Board of Directors

By Nancy Johnson, Recording Secretary


President Ann Byington convened the meeting of the board of directors January 21, 2012, at the corporate office.  Eleven directors were present.

Approval of credit card transactions was discussed.  The bank is now charging $20 per month for their services whether or not a credit card is used.  They offered a program for seasonal use of credit cards.  It was decided to use this option.  KABVI can no longer renew memberships with credit cards while service is down.  Credit cards will be accepted during golf tournament and convention times.  PayPal is being investigated.

Grant funding for the office manager is expired.  The board agreed to keep Colleen Talley working through March, which will take the organization through its heaviest work season, and beyond if funding is procured.    Using volunteers to assist with some office work was discussed.   

The Kansas Advisory Committee for the Blind and Visually Impaired (KACBVI) met January 19, 2012.  The committee is looking for a parent of a visually impaired child.  Interested parents should notify the office of Michael Donnelly.

            Ann Byington appointed a Grants Committee consisting of Colleen Talley, Nancy Johnson, and Michael Byington to work with fund raising. 

            Convention sites were reviewed with three potential sites available. 

1.      Hold the convention at the Kansas State School for the Blind (KSSB) in conjunction with the Kansas Association for Education and Rehabilitation of the Visually Impaired (KAER).

2.      Holiday Inn, Lawrence

3.      McPherson Best Western. 

After comparing the offerings of each and a six to five vote of board members present, Kansas City was chosen as the 2012 convention site.  KABVI’s convention will immediately follow the KAER meeting.  Accommodations will be available at the School for the Blind and, for those who prefer not to stay in the dormitory, near-by hotel accommodations are available.  This arrangement will go a long way toward reducing the cost of the convention for KABVI and its members.  Dates will be coordinated with the KAER conference and announced in the summer issue of KABVI News. 

Two $1,000 scholarships are offered again this year.  The application is available on the kabvi.com website, at the end of this newsletter, or by contacting the KABVI office.  Application deadline is April 15, 2012.  When packets are sent, envelopes will state scholarship information is enclosed. 

Annual membership letters have been sent.  If you did not receive one, please contact the KABVI office to let us know so we can make certain our address information for you is correct.

Monthly conference calls are planned at 7:00 PM CST the third Monday of each month.  Presenters are scheduled for the first part of the calls.  February 20, Dana Carter, of Talking Books is scheduled. 

Michael Byington plans to attend the American Council of the Blind annual President’s and Legislative meetings. 

KABVI’s current legislative concern involves the rights of parents with disabilities and their children.  A parent’s disability alone must not be grounds for removing a child from the home.

Nancy Johnson apologized for the lateness of sending KABVI News.  She thanked Ann Byington and Colleen Talley for their help. 

KABVI’s website is receiving 115 hits per day, so it is being used.  The board encourages the use of Face Book as well.  Paul Berscheidt has added a good deal of information on Face Book.

The next meeting of the Board of Directors is scheduled for April 21, 10:30 AM, at the corporate office.  Meetings are also scheduled for July 21 and the post-convention board meeting.


How Does Work Affect My Check Benefits?

Retrieved from http://www.ssa.gov/work/receivingbenefits.html#check 2/1/2012


First, you should know that if you go back to work, you will NOT automatically lose your disability benefits. The Ticket to Work and special rules called "work incentives" allow you to keep your cash benefits and Medicare or Medicaid while you test your ability to work. For the Social Security Disability Insurance (SSDI) program, there is a trial work period during which you can receive full benefits regardless of how much you earn, as long as you report your work activity and continue to have a disabling impairment.

The trial work period continues until you accumulate nine months (not necessarily consecutive) in which you perform what we call “services” within a rolling 60-month period. We consider your work to be “services” if you earn more than $720 a month in 2012.  This amount is unchanged from 2011. After the trial work period ends, your benefits will stop for the months your earnings are at a level we consider "substantial" -- currently $1,010 in 2012. This amount is changed from 2011. For 2011, this amount was $1,000. Different amounts apply to people who are disabled because of blindness. The monthly SGA amount for statutorily blind individuals for 2012 is $1,690. For 2011, this amount was $1,640.

For an additional 36 months after completing the trial work period, we can start your benefits again if your earnings fall below the "substantial" level and you continue to have a disabling impairment. For more information about work incentives, we recommend that you read the pamphlet, Working While Disabled-How We Can Help (SSA Publication Number 05-10095).

If you receive Supplemental Security Income (SSI) your work may affect the amount of your check. However, we do not count the first $65.00 of earnings in a month plus one-half of the remainder. This means we count less than one-half of your earnings when we figure your SSI payment amount. You may still qualify for other work incentives, such as Ticket to Work, and continue to receive Medicaid.

While participating in the Ticket to Work Program, you may be able to use a combination of other work incentives to maximize your income until you begin to earn enough to support yourself. Some of these work incentives include:

A Trial Work Period (TWP)

Expedited Reinstatement of Benefits (EXR)

Deferral of continuing disability reviews (CDR)

A plan for achieving self support (PASS)

To find out specifically how your participation in the Ticket to Work Program could affect your disability benefits, you may contact a Work Incentives Planning and Assistance (WIPA) project in your state. You can find a list of the WIPA projects by state using the Service Provider Directory.




Tantalizing Tidbits


New Voices in Talking Books:  We are happy to have Hillary McHenry as a new member of the Kansas Talking Books network.  Hillary joins the Emporia staff as library assistant/production manager.  She will be working with our recording program to produce Kansas titles in the NLS digital format and spearhead the development of access to locally produced magazines onto digital cartridges.  Hillary is a graduate of ESU's library school.  She has been an Emporia resident since 2008 and comes to us with experience as a teacher and school librarian.  We look forward to the possibilities for expanded services and resources as we move through the New Year.

We also recently received approval to fill the Readers' Advisory position vacated by Mike Hall in late November.  We are happy to announce that Kathryn (Katy) Patrick will join the Emporia staff as a Readers Advisor on January 26.  Katy is also an ESU library school graduate.  She is an avid reader of many types of books, but fills a particular niche in that she, like Mike, has a passion for science fiction/fantasy.  As a college student and graduate assistant, Katy worked in libraries providing reference and technical support services.  Katy also served as a board member with the Emporia Public Library's Friends group while attending ESU.

We feel fortunate to have these two individuals join the existing talents throughout the Kansas Talking Books network.

E-learning Opportunities The American Foundation for the Blind offers digital learning through online publications, webinars, and online courses available through its fully accessible eLearning Center.  You can find courses on aging, vision loss, and employment.  There are a number of great courses to choose from, with more on the way.  Please check them out and let us know what you would like to learn about in the future.  Additionally, the eLearning Center and AFB CareerConnect offer the Job Seeker's Toolkit, a free self-paced, online course on the employment process.  The course is aimed at helping teens and young adults prepare for employment.  You can navigate this digital offering and become more self-aware, build tools such as your resume and cover letter, and prepare for that interview!

Application for reading DAISY books on smart phones: The Darwin Reader for Android, created by New Designs Unlimited, recently released a new product for reading DAISY books on smart phones that use the Android operating system. Android users who are blind and dyslexic can now use this application (app) to access DAISY digital Talking Books anywhere without having to carry along an additional single-purpose player. Darwin Reader for Android supports all varieties of DAISY digital Talking Books, including DAISY 2 and DAISY 3 text and audio formats, and the app is designed to easily transfer books from a computer to a phone. The app also directly integrates with Bookshare, a source of accessible books for people with print disabilities, to make finding new books simple for qualified Bookshare members. The Darwin Reader is available on the Android market for $3.95; a 30-day trial version is available, as well. For more information, contact: Darwin Reader, New Designs Unlimited; phone: 888-868-6159; web site: <www.darwinreader.com>.  Journal of Visual Impairment and Blindness.  January, 2012, p. 54.  Retrieved from http://www.afb.org/afbpress/pubjvib.asp?DocID=jvib060109.  





In Memoriam


Robert “Bob” Dawson, 87, retired Military USMC, operator of the concession stand at Southwestern Bell, 2nd and Main, Wichita, passed away December 20, 2011.  Bob was preceded in death by his wife of 40 years, Marie Dawson and a son, John Worthan.  Survivors include sons, Bruce Dawson of Liberty, MO, Mark Dawson of Colorado Springs, CO, Greg Dawson of Chicago, IL, Kip Dawson of Wichita, James Worthan of Wichita, Tim Worthan of Portland, OR, Mark Worthan of Oklahoma, Dave Worthan of Wichita; sister, Dorothy Pond of Andover; 17 grandchildren; and 26 great-grandchildren. www.hillsidefuneralhomeeast.com.  Published in The Wichita Eagle from December 21 to December 22, 2011


Gary L. Pope, 74, passed away January 23, 2012 at St. Francis Hospital in Topeka.  He was born April 17, 1937 in Pottawatomie County, Kansas the son of William A. and Jean Delores Melenson Pope.  He grew up in St. Marys, graduated from St. Marys High School, and attended Washburn University in Topeka.  Gary served in the Kansas National Guard 174th Military BN, being honorably discharged in 1995.  Gary worked at the St. Marys Manor, Topeka State Hospital, Psychiatry Department, and McCormick's Carpet and Tile Company in Topeka.  He retired from the Rehabilitation Center for the Blind and Visually Impaired in 2005. Gary lived most of his adult life in Topeka.  He was a member of Holy Name-Mater Dei Catholic Church. He was married to Janice Hasting in 1958 and later to Jane Dix. Mr. Pope was preceded in death by his parents, a sister, Shirley Pope and a brother, James Pope.  Survivors include his children Michael Thomas Pope and Karen K. Howard, Lexington, KY, and Steven Joseph Pope, New Bern, NC; two brothers, William E. Pope, Mission Viejo, CA, and Michael Joseph Pope, Sacramento, CA; his sister, Mary Jean (David) Peterson, Wamego; and three grandchildren. Memorial Contributions may be made to Holy Name-Mater Dei Catholic Church or Mass Offerings and sent in care of Piper Funeral Home 714 Maple St, St. Marys, Kansas 66536. To leave online condolences please go to www.piperfuneralhome.com.  Published in Topeka Capital-Journal on January 24, 2012.


HOLLAND_LOWELL_1092754810_221126Lowell E. Holland, 86, Oklahoma City, died January 27, 2012Lowell was born March 6, 1928, to Ernest E. and Myrtle Holland in Loraine, Texas. He served in the United States Marine Corps, receiving the Purple Heart for his service in the Korean War, where he lost his eyesight in frontline combat.  Lowell attended Bethany Nazarene College, Oklahoma University, and Texas Tech University, receiving degrees in social science, educational counseling and guidance, and rehabilitation.  Lowell worked for the state of Kansas for over 30 years, serving as an administrator of the Kansas Rehabilitation Center for the Blind in Topeka, Kansas. After retirement, Lowell and June traveled extensively in their RV, and devoted time to work and witness trips in Casa Robles, California, and Kenya, Africa.  Lowell devoted his life to serving the Lord and others through his service in rehabilitating the blind, and serving in the Nazarene Church. He was a member of Fairlawn Church of the Nazarene while in Topeka.  He received both the Outstanding Alumni Award and the "B" Award from Southern Nazarene University. In his spare time, he enjoyed woodworking and creating lamps, furniture, and other items Lowell left behind a legacy of Christian faith to his daughter, Cyndi Lackey, and husband Lyndel, from Oklahoma, City; his three grandchildren, Jonathan, Juliana, and Jace; as well as many family and friends who were touched by the positive, strong spirit he portrayed.  In lieu of flowers, donations may be made to the Southern Nazarene University Scholarship fund. To share a memory or condolence, visit www.mercer-adams.com.  Published in The Oklahoman from January 29 to January 30, 2012


Directors, 2012


Please send all correspondence e-mail, surface mail, or phone contacts, to: 

KABVI, 603 SW Topeka Blvd., Suite 304, Topeka, Kansas 66603.

Telephone:  785-235-8990 or, in Kansas only, 1-800-799-1499.

E-mail:  kabvi@att.net.  Web sites:  www.kabvi.com and www.kabviyouthconnection.com.


Ann Byington, President                               abyington@cox.net              

Beulah Carrington                                         b1car@sbcglobal.net

Bill Moore                                                       bmr@kni.ks.gov

Bob Chaffin, Treasurer                                 chaffin@ruraltel.net              

Henry Staub                                                   hstaub@cox.net

Joann Vine                                                     joannvine@sbcglobal.net

Jonathon Marcotte, Vice President            jonathonmarcotte@gmail.com       

Marilyn Lind                                                   ms.delta1976@yahoo.com

Michael Byington                                           byington@cox.net

Mikel McCary, Membership Secretary       mikel.mccary@gmail.com              

Nancy Johnson, Recording Secretary        supermom1941@sbcglobal.net     

Paul Berscheidt, Webmaster                      pberscheidt@kitusa.com                



2012 KABVI Membership Application


___ Enclosed is $10.00 for my 2012 KABVI dues.

___ Enclosed is $250 for my Life Membership.


NAME: ____________________________________________________


ADDRESS: _________________________________________________


CITY___________________________________ STATE: _____________


ZIP: ________________ TELEPHONE:  (        ) _______-_____________


E-MAIL ADDRESS: ____________________________________________


Are you:  ____ Legally blind   ____ Visually Impaired    ____ Deaf-blind    ____ Sighted


I would like the KABVI NEWS and THE BRAILLE FORUM in:  ____ Braille ____ Large print ____ Cassette ____ Regular print ____ E-mail      _____I do not want these publications.


I am including a tax-deductible donation to KABVI in the amount of $_________._____.


SEND this form and your enclosed check to:

Robert Chaffin, Treasurer

1105 Centennial Blvd.

Hays, Kansas  67601.



Kansas Association for the Blind and Visually Impaired

Esther V. Taylor Scholarship Supplemental Sheet


The Kansas Association for the Blind and Visually Impaired (KABVI) will award two $1,000 scholarships to visually impaired students enrolled in an academic, vocational, technical or professional training program beyond the high school level.  The KABVI scholarship committee will accept applications from residents of Kansas enrolled in a college, university or technical school.  Material must be postmarked on or before April 15, 2012. Send the completed application and all supporting documents to:  Robert Chaffin, 1105 Centennial Blvd., Hays, Kansas 67601

Esther V. Taylor, for whom this scholarship is named, was a charter member of the Kansas Association for the Blind and Visually Impaired.  She became a music teacher and taught at the Kansas State School for the Blind.  Esther helped craft early special education laws in Kansas long before special education became a mandate of the Federal government.  In her eighties, Esther wrote an autobiography, "The Professor's Family" about herself and her sister, Eleanor, exploring the challenges of growing up and becoming educated as blind women during the early 1900's. Esther particularly wanted blind students to be problem-solvers and as resourceful as their sighted peers in coping with the challenges of academics, employment and everyday life.

NOTE:  Please DO NOT MAKE copies of this application as committee members, who are blind or visually impaired themselves, will be reading Xeroxed copies of your application using CCTV’s and/or scanning software.  To request additional copies of this material, call (800)-749-1499 or e-mail kabvi@att.net.


Eligibility Criteria

To be eligible for a scholarship the applicant must:

(1)  Be a visually impaired student admitted to a post-secondary training program for the                 2012-13 school year 

(2)  Be a resident of Kansas

(3)  Submit a completed, application form together with the required supporting documentation     postmarked on or before April 15, 2012.


Required Documentation

To be considered for a scholarship the student must submit the following items:

(1)    A completed application form:

(2) An autobiographical sketch (please update if you have applied previously) of no more than two double-spaced, typewritten pages. This sketch should include goals, strengths, weaknesses, hobbies, honors, extracurricular activities, achievements, etc. This must be typed; hand-written material will not be accepted.

(3) A certified transcript from the school presently, or most recently attended.

(4) Two letters of recommendation from current or recent instructors

(5) Proof of acceptance from a post-secondary school.  Entering or transferring students must submit a letter of acceptance from the admissions office.

(6) Certification of visual status on the form attached to this application.

Recipients of this scholarship will receive a one-year free membership to KABVI.



Esther V. Taylor Scholarship Application Form



         A. Name, mailing address, and telephone number:


      Name: _______________________________________________________


                  Address ______________________________________________________


                  County ____________________________


                  Phone number (     ) _______-_______________


         B. Are you a U.S. Citizen? Yes _____   No _____



         A. Name and address of the school you are currently attending or have completed (Secondary and post-secondary schools) _______________________________________________________________


                  1.   Enrollment status:  ____ Full time   ____ Part time


                  2.   Number of hours completed to date. ___________


                  3. Major ___________________________ GPA (based on 4.0 scale) ______


                  4. Degree/certificate/diploma sought:  BA, BS, MS, etc. __________


                  5. Date you expect to receive it. _________________


         B. Name and address of the school you plan to attend during the semester for which you                              are applying for this scholarship (if different from A. above):



1.      Enrollment status:  _____ Full time             ______ Part Time

2.      Number of hours you are planning to take per semester __________

                  3.  Major _______________________________

                  4.  Degree/certificate sought: BA, BS, MS, etc. ________

                  5.  Date you expect to receive it: ______________ 





         Are you eligible for other financially based student aid?                 Yes_____      No_____




         A.     Completed application.


         B.     Typed autobiographical sketch: include work experience, extracurricular activities, and/or volunteer service.


         C.     Certified transcript from the school you are attending or most recently attended.


         D.     Two letters of recommendation from current or recent instructors.


         E.     Proof of acceptance from a post-secondary school.


         F.      Certification of visual status on the attached form.



Certification of Visual Disability


(This form is to be completed by an ophthalmologist, optometrist, physician, vocational rehabilitation counselor, or independent living center counselor.)


I certify that __________________________________ is known to me and is Visually Impaired as specified by the following definition:


"Visual acuity best corrected with conventional spectacles or contact lenses of 20/60 or worse in the better eye, or a visual field restricted to 20 degrees or less in each eye." This also includes those certified as legally blind.


Date of examination: _____________________________


This is a permanent condition: Yes ______          No _______


Certifier’s Name: _________________________________


Degree: ________________________________________


Title/ Agency: ______________________________________________________________


Address: __________________________________________________________________


Phone: _________________________________________


Signature: _______________________________________