SCHOLARSHIP APPLICATION FOR STUDENTS WITH

DISABILITIES AT WESTERN MICHIGAN UNIVERSITY

2018-2019 ACADEMIC YEAR

Instructions for completing application:

  • Students must be registered with the Disability Services for Students, and be eligible for services under the University Americans with Disabilities Act standards in order to be considered for scholarships.
  • Complete the entire application. Incomplete or late applications will eliminate you from scholarship consideration.
  • Please print legibly or type your responses to each item below.
  • Include a typed, double-spaced 500 wordessay describing an academic challenge you have faced due to your disability.
  • Have the section titled “Reference Form” be completed by someone acquainted with your academic record (individuals unrelated to you).
  • Application is due to the Disability Services for Students, Friday March 30, 2018 by 5:00 p.m.

Name ______

Phone (_____)______Date of Birth ______

Student WIN #______Major______

Local Address ______

City/State______ZIP______

Home Address ______

City/State______ZIP______

E-mail Address______

Please submit completed application, personal essay, and reference form to:

Application can be mailed, faxed or emailed:

Disability Services for Students

ATTN: Jimmy Brand

Western Michigan University

1903 W. Michigan Avenue

Mail Stop 5277

Kalamazoo, MI 49008-5277

Phone: (269) 387-2116 Fax: (269) 387-0633

Applicants are required to write an essay forone of the followingtopics. The Award committee will consider the quality of your writing, but is most interested in your creativity.

***Essays should be typed, double-spaced, Times New Roman, 12 front and no longer than 500 words.

Essay topic:

1.)Describe your disability and how it has impacted your life (i.e., academically, professional goals, self-image, etc.).

2.)What advice would you provide a student with your disability that is interested in attending college?

3.)How would you describe diversity and how it related to you?

Please submit completed application, personal essay, and reference form to:

Application can be mailed, faxed or emailed:

Disability Services for Students

ATTN: Jimmy Brand

Western Michigan University

1903 W. Michigan Avenue

Mail Stop 5277

Kalamazoo, MI 49008-5277

Phone: (269) 387-2116 Fax: (269) 387-0633

Reference Form

Dear ______

I am applying for a scholarship and request that you complete this Reference Form and return it to me in a sealed envelope. The scholarship committee of Disability Services for Students at Western Michigan University must receive my application, along with your reference, by March 30, 2018.

Scholarship Applicant Information

Applicant's Name:______

Address:______

City:______State:______Zip Code:______

Phone:______Cell:______

  1. I have known this person:

____ less than one year. ____ casually.

____ one to two years. ____ fairly well.

____ more than two years. ____ very well.

2. In the relationship of: (check all that apply)

____ student in class. ____ volunteer.

____ employee. ____ colleague.

____ other, specify ______

3. In your opinion, why would this student be a good candidate for a scholarship?

______

______

______

______

Reference Information

Name:______

Title:______

Address:______

City:______State:______Zip Code:______

Phone:______Cell:______

Your SignatureDate Signed

Please return this Reference Form to the applicant in a sealed envelope. You may also return this reference form to the following address or fax. The application packet is due to the Scholarship Committee no later than March 30, 2018 at 5:00 p.m.

Please submit completed application, personal essay, and reference form to:

Application can be mailed, faxed or emailed:

Disability Services for Students

ATTN: Jimmy Brand

Western Michigan University

1903 W. Michigan Avenue

Mail Stop 5277

Kalamazoo, MI 49008-5277

Phone: (269) 387-2116 Fax: (269) 387-0633

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