John Streff
Scholarship Application Form
Complete this form and return it to the Vision Leads Foundation Scholarship Committee along with:
- A certified graduate school transcript
- Two letters of recommendation (one from a professor and one from an optometrist)
- Evidence of participation in an optometric vision therapy clinic during clinical rotations
- The essay described below
Mail (postmark) all materials by midnight, April 1, 2016 to:
Vision Leads Foundation
P.O. Box 562
Elm Grove, WI 53122
Applicant’s Name:______
Date of Birth______SS# ______/______/______
Address:______
City:______State:______Zip______
Phone:______Email:______Optometry School Attending: ______
MM/YY of graduation: ______
The following should also be on your official transcript:
Cumulative GPA:______Expected date of graduation: ______
List academic honors and year received
______
______
______
List acknowledgements of merit, caliber, excellence, virtue or value and year when received:
______
______
List your chief interests and activities in optometry school:
______
______
______
List any community activities you have pursued, including any jobs you have held and volunteer work, with corresponding dates:
______
______
______
ESSAY: The John Streff Optometry Student Scholarship is awarded to a student exhibiting a strong interest and intent to study and pursue a career in optometric vision therapy. Dr. John Streff loved sharing his knowledge with optometry students. When asked a question, his eyes would light up and he would proceed in sharing a piece of information about vision that always made the student think. Dr. Streff strived to understand vision and shared his knowledge in teaching, lecturing and writing. His joy was to inspire students to think.
Please attach to this application an essay that will acquaint the selection committee with the nature of your interest in optometric vision therapy – what inspired your interest, what have you done to prepare yourself, what have you learned and accomplished already, and what are your aspirations in the field – and in particular: how you believe you might be able to change the world for the better by providing optometric vision therapy.
Note: This scholarship award may be subject to revocation if the recipient substantially alters
his or her intent to study and pursue a career in optometric vision therapy prior to completion of residency. You are therefore asked to certify the following statement:
I certify that it is my intent to study for and pursue a career in optometric vision therapy. If I am awarded the John Streff Optometry Student Scholarship and change my plans before enrolling in a non-related residency, I will notify the committee and arrange for the return of any scholarship award funds remitted.
I certify that all the statements made in this application form are true, complete and correct to the best of my knowledge and belief and are made in good faith.
Signature______Date ______