PCB Convention Student First Timer Scholarship

                                                                                                                          Date: 
Full Name: 
Mailing Address: * Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry
E-mail Address: * 
Home Phone: * - 
Area Code Phone Number
Mobile Phone: - 
Area Code Phone Number
Please answer the following questions:
1. What is your date of birth? *  /   /  
day month year
2. Are you male or female? * Male
Female
3. What school are you currently attending? * 
4. What level of education are you currently working to achieve (high school, Bachelor’s, Master’s, etc.)?  * 
5. How did you hear about this scholarship? * 
6. Have you ever been involved with the Pennsylvania Council of the Blind, or any other affiliates or chapters of the American Council of the Blind?  If so, please provide details of such involvement. * 
7. In 100 words or less, describe why you wish to attend the PCB convention. * 
8. Would you like to be involved with helping to reactivate the Pennsylvania Alliance of Blind Students, and organize other students throughout the Commonwealth? And why? 
9. If chosen for a scholarship, are you able to assist in paying for any of your own expenses?  Please provide examples of what you could afford (transportation, registration, meals, hotel, etc.). * 
NOTE: Students provided with this scholarship will be expected to have a roommate during convention, which PCB will work with you to provide.  If you choose to bring someone with you to the convention, that person is expected to pay for their own expenses, including his or her half of the hotel room.  Also, please understand that this scholarship is not an academic scholarship, and financial assistance is solely for purposes of convention attendance.	Please note students under the age of eighteen can bring along a parent or legal guardian underscholarship expense. Students under age of eighteen arriving unaccompanied by parent or legal guardian must have completed a written and signed release of liability form provided by the PCB Office.
type_submit_reset_25