Scholarship Application Due March 8, 2013

Name__________________________________________________________________ IU ID #_____________________________ Last First M.I. Email Address_________________________________ Home Town____________________________ Phone # _____________________ ________ Current GPA_______

Anticipated Graduation date________

Disabilities__________________________________________________________________________________________________ Major(s)/Minor______________________________________________________________________________________________ Please check the scholarship(s) for which you are applying: ___Sara Ellen and Alan J. Feldman Fund Student assistance fund for students with limited mobility, possibly who use wheelchairs or braces. Students with financial need will receive greatest consideration. ___Russell R. and Dorothy Judd Scholarship Scholarship for students with visual impairments who have at least a 3.00 GPA. ___Homer E. Marsh Scholarship Scholarship open to all students with disabilities. Preference given to students with demonstrated financial need. ___William H. Morris Endowment Award open to all students with disabilities to pay for special equipment, travel arrangements, tuition, or fees. Preference given to a student in the School of Business. ___Class of 1952 Disabled Student Scholarship Scholarship open to all students with disabilities. ___Liff Family Scholarship Scholarship for students with learning disabilities who have at least a 3.00 GPA. Preference given first to a student who is a resident of Davidson County, Tennessee, second to a resident of Tennessee, and third to a resident of Indiana. ___Amanda Meredith Mills Memorial Scholarship Scholarship open to all students with disabilities who are U.S. citizens and have a 2.50 GPA. Preference given to students who have overcome or who are living with physical challenges, psychiatric disorders, or Aspergers Syndrome. ___Dr. and Mrs. Harold A. Cohen Scholarship renewal Scholarship for incoming freshmen who have visual, auditory, and/or significant physical impairments or returning students who previously received the scholarship. Attach a brief personal statement addressing the following questions How would this scholarship assist you to achieve your academic goals? How do you meet the criteria of the scholarship(s) for which you are applying? Note: If you are applying for multiple scholarships, you only need one application and personal statement. Release to Review Records: By my signature below I hereby give permission to the Office of Disability Services for Students (1) to review my academic transcript and other university records to determine my eligibility for the awards (2) to exchange information with the IU Office of Student Financial Assistance as needed and appropriate, relevant to my eligibility for the awards (3) to announce my name as a scholarship recipient ______ Yes ______ No ______________________________________________________________________ Signature Date Please submit all applications to DSS, Wells Library W302 or dorwells@indiana.edu Thank you for your interest!