STATE UNIVERSITY SYSTEM OF
2008-2009
THEODORE R. AND VIVIAN M.
JOHNSON SCHOLARSHIP*
DEADLINE FOR APPLICATION
MATERIALS TO BE RECEIVED BY THE UNIVERSITY(IES): MAY 15, 2008
*This program is contingent
upon annual funding by the Theodore R. and
Vivian M. Johnson Scholarship
Foundation, Inc. and matching funding by the
The Johnson Scholarship, funded by the Theodore R. and Vivian M. Johnson Scholarship Foundation, Inc., is a competitively awarded program which is available to undergraduate students with disabilities with financial need who enroll in a State University System of Florida (SUS) institution. You must adhere to the following application guidelines in order to qualify for full consideration.
In order to demonstrate financial need, all applicants must complete a 2008-2009 Free Application for Federal Student Aid (FAFSA) or Renewal FAFSA form, and mail it to the appropriate address as indicated on the FAFSA form. To receive full consideration, the FAFSA should be mailed or completed on-line no later than April 15, 2008.
INITIAL APPLICANTS MUST:
Provide an official current transcript (not a photocopy) which documents a cumulative grade point average of at least 2.0 (on a 4.0 scale) on all credits. High school students who are applying for the first year of college should submit a current high school transcript.
Provide documentation of the nature and/or extent of
a disability. The disability must be in
one or more of the following classifications:
hearing impairment, physical impairment; specific learning disability;
speech/language impairment; visual impairment; or other impairment. Appropriate documentation includes, but is
not limited to, either a recent psychological evaluation used to determine eligibility
for exceptional student services, school/medical records, certification by the
Division of Blind Services, or a Vocational Rehabilitation eligibility
determination. Documentation provided
must meet the guidelines require by the institution in which the student is
enrolled. Students must contact the
University Office of Student Disability Services for clarification as to what
is required.
Gain admission as a degree-seeking undergraduate
student into a State University System of Florida (SUS) institution.
Have a demonstrated financial need (determined from
FAFSA information).
Be determined to be
Submit the following:
-
A completed 2007-2008 Johnson Scholarship Application Form;
-
A current official transcript
-
Documentation of a disability(ies);
-
A personal statement (no more than one double-spaced page) pertaining
to your achievements, activities, career goals, and the effects of your
disability(ies); and
-
Three letters of reference addressing your academic success and
potential.
-
Mail or complete on-line a 2008-2009 FAFSA form as indicated above.
RENEWAL APPLICANTS MUST:
Continue to have financial need and adhere to minimum enrollment, progress, and grade point average requirements of the program, plus:
-
Submit a completed 2008-2009 Johnson Scholarship Application Form to
the desired SUS institution;
-
Mail or complete on-line a 2008-2009 FAFSA form as indicated above.
Note: Former
out-of-state Scholarship recipients who are eligible may continue to seek
renewal.
APPLICATION PROCEDURES:
If you apply for admission at more than one SUS institution, submit completed Johnson Scholarship application materials to each university. The application should be sent to the contact person listed at the end of this form.
Applications, disability documentation, personal
statements, letters of reference, and an official transcript must be received by the institution(s) no later than
May 15, 2008.
All applicants will be notified of their status as Johnson Scholarship recipients, alternate award candidates, or as students who were not selected. Notification letters will be mailed in July to the permanent address which is specified on the application forms.
IF SELECTED, RECIPIENTS MUST:
Complete and return an acceptance form by the date
specified on your notification letter.
Failure to return the acceptance form by the specified date will result
in forfeiture of the award.
First-time recipients must participate in a Johnson
Scholarship orientation.
Complete a minimum of nine (9) credit hours each
semester.
Adhere to the minimum 2.0 cumulative grade point average
requirement of this program.
Apply for renewal consideration for each academic
year in which you desire the award.
Johnson Scholarship recipients may qualify for the award for up to
twelve (12) semesters of undergraduate study.
After verification of enrollment, the university
will disburse the award on a prorated basis each academic term to eligible
Johnson Scholarship recipients. The
dollar amount of the 2008-2009 awards is contingent upon the level of funding
from the Theodore R. and Vivian M. Johnson Scholarship Foundation, Inc. and the
Florida Legislature.
FOR ADDITIONAL INFORMATION:
Call or write the appropriate university representative listed on the last page.
Johnson
Scholarship
funded by
Theodore R. and Vivian M. Johnson Scholarship Foundation, Inc.
2008 – 2009 Application Form
This form and
supporting application materials must be received by the appropriate
All applicants must also complete a 2008 – 2009 Free Application for Federal Student Aid (FAFSA) form or Renewal FAFSA form on-line or mail it to the address indicated on the FAFSA form by April 15, 2008 in order to receive full consideration. PLEASE PRINT OR TYPE.
_____Initial Application _____Renewal Application
NAME:_______________________________________________________________
Last First Middle Initial
SOCIAL SECURITY NUMBER:________________________ E-mail Address: ________________
CURRENT ADDRESS:______________________________________________________________________
Street Address
________________________________________ Telephone:_____________
City State Zip
CHECK ALL DISABLING CONDITION(S) THAT APPLY:
_____Hearing Impairment _____Speech Impairment _____Visual Impairment
_____Physical Impairment _____Specific Learning Disability _____Other Impairment
CURRENT CUMULATIVE GPA:_____
UNIVERSITY:_____________________
HAVE YOU BEEN ADMITTED TO THE UNIVERSITY? (check
one) ___Yes ___No
2007 – 2008 ACADEMIC LEVEL:
(check one)
_____Freshman
_____Sophomore
_____Junior _____Senior
ANTICIPATED UNIVERSITY GRADUATION
DATE:_______________________
SELECTIVE SERVICE REGISTRATION
_____I am registered with the Selective Service
_____I am not required to be registered with the
Selective Service because:
_____I am female.
_____I am in the armed services on active duty (Note: This exception does not apply to
members of Reserve and
National Guard units who are not on active duty).
_____I have not reached my 18th birthday.
_____I was born before 1960.
_____I am a citizen of the
permanent resident of the Trust Territory of the Pacific Islands (
_____Other (please specify):______________________________________
(continue next page)
CITIZENSHIP STATUS (check one):
_____I am a
_____I am a permanent resident alien.
_____I am a non-U.S. citizen or non-permanent
resident alien and possess the following
category of VISA (specify):______
ETHNIC ORIGIN (check one*):
_____Alaskan Native _____Asian _____Black (non-Hispanic)
_____American Indian _____Hispanic _____White (non-Hispanic)
_____Pacific Islander
(*Failure to disclose your ethnic origin will not
disqualify your application)
Initial applicants must submit to the appropriate
University:
-
A completed 2008-2009 Johnson Scholarship Application;
-
A current official (not a photocopy) transcript;
-
Appropriate documentation of the nature and/or extent of a disability;
-
A personal statement pertaining to your achievements, activities,
career goals; and
-
Three letters of references addressing your academic success and
potential.
-
You must also mail or complete an on-line FAFSA form to the address
indicated on the FAFSA form by April 15, 2008.
Renewal applicants must submit the following to the appropriate University:
-
A completed 2008-2009 Johnson Scholarship Application.
-
You must also mail or complete an on-line FAFSA form to the address
indicated on the FAFSA form by April 15, 2008.
I certify that I have read and understood the conditions for participation in this program. The information I am supplying in this application is true, complete, and correct. By signing the form, I also grant permission for information pertaining to my financial need, and all supporting application materials, to be released by the appropriate university to the Board of Governors Office for Academic and Student Affairs. NOTICE: If you purposely give false information, you may be subject to fine, or imprisonment, or both under 827.06, F.S.
_________________________________ _______________________
(Signature) (Date)
SUBMIT APPLICATION MATERIALS TO THE APPROPRIATE CONTACT PERSON(S) LISTED AT THE END OF THE APPLICATION.
University Contacts
Submit a completed 2008 – 2009 Johnson Scholarship application form and supporting materials to the appropriate contact(s) listed below:
Dr. Nathaniel Holmes
Director, Learning Development
and
V: (850) 599-3180
TDD:
(850) 561-2757
Ms.
Nicole Rokos, Director
Office
for Students with Disabilities
Post
Office Box 3091
Voice: (561) 297-3880
TDD: (561) 297-0358
Ms.
Cori Bright
Office
of Adaptive Services
V: (239) 590-7956
TTY:
(239) 590-7930
Ms.
Amanda L. Niguidula, MPA
GC
190
TDD/V: (305) 348-3852
V: (305) 348-3532
Ms.
Bea Awoniyi
Assistant
Dean of Students
Director
of
V: (850) 644-9566
TDD: (850) 644-8504
Fax: (850) 644-7164
Mr.
Christopher Pantzis, Director
Student
Disability Services
5700
V: (941) 359-4254
Ms.
Louise Friderici, Associate Director
Student
Disability Services
V: (407) 823-2371
TDD
Only: (407) 823-2116
Learning Specialist
Building
0020 (Reid Hall)
Post
Office Box 114085
V: (352) 392-8565 Ext. 205
TDD: (352) 392-3008
FAX: (352) 392-8570
Dr.
Kristine Webb, Director
Dr.
Robert E. Lee, Associate Director
TDD/V: (904) 620-2769
Dr.
Jose Hernandez, Director
Diversity
& Equal Opportunity
V: (813) 974-4373
TDD: (813) 974-5651
Assistant Dean of Students
Building 18/130
V: (850) 474-2161
Fax: (850) 850-857-6188