The Anne Ford and Allegra Ford Scholarship 2010-2011 National Center for Learning Disabilities Deadline for Submission: The Anne Ford and Allegra Ford Scholarship is a $10,000 award given to two high school seniors with identified learning disabilities (LD) who will be pursuing four-year undergraduate degrees.
Eligibility and Selection Criteria
The National Center for Learning Disabilities, Inc. (NCLD) is seeking applicants for the Anne Ford and Allegra Ford Scholarship, which is available to students of high merit with an identified learning disability (LD). To be
eligible for the Anne Ford and Allegra Ford Scholarship, an applicant must:
Have an overall grade point average (GPA) of 3.0 or higher on a 4 point scale (or equivalent)
Provide most current documentation of an identified learning disability
Note: ADD/ADHD alone is not considered a learning disability; eligible candidates with
ADD/ADHD must also provide documentation of a specific learning disability
Be enrolled as a senior in high school, public or private, with the intention of pursuing a 4-year undergraduate degree
Students of minority background are encouraged to apply.
The Ideal Anne Ford and Allegra Ford Scholar The ideal candidate is a high school senior who:
Can articulate his/her learning disability, understands how LD affects his/her life, and recognizes the importance of self-advocacy;
Is committed to completing a four-year college degree and has begun to set realistic career goals;
Has demonstrated perseverance and embraces new opportunities;
Has a well-rounded perspective shaped by experiences in school, in the community, and with family and friends;
Believes in contributing to society in ways that increase the opportunities for individuals with learning disabilities; and
Feels comfortable serving as a role model and spokesperson for others who struggle with LD.
Mentoring and Outreach Opportunities
The Anne Ford and Allegra Ford Scholar must be willing to mentor future Scholars and act as a role model for individuals with LD through such activities as public speaking, writing for publications, and engaging in other
opportunities made possible through NCLD. Application Requirements Scholarship applicants must submit the following materials in one packet in order to be considered for the scholarship:
2. A resume outlining academic, extracurricular, community, and/or work involvement
3. A personal statement, describing the applicant’s frustrations and triumphs in dealing with his or her specific
learning disability. Applicants should feel free to express themselves in creative ways, and be sure to share how they embody the characteristics of an ideal candidate (as described above). The statement should make specific mention of how he/she believes a college education will enhance his/her life.
(This may be submitted as a written essay of 750-1000 words or in video/audio format no longer than 15 minutes in length. Tapes should be accompanied by a written script and/or outline and must be clearly labeled with the candidate’s name).
4. A high school transcript. Applicants should contact their school guidance office or the appropriate school
administrator to obtain a copy (unofficial transcripts will be accepted).
5. Three (3) letters of recommendation.
Instructions: Each letter of recommendation must be attached to a copy of the Letter of
Recommendation Form (found on page 6), and each must be enclosed in a separate sealed envelope and included in the complete application packet. At least one letter should come from a teacher, past or present.
6. A financial statement (see page 7 of application). 7. Standardized test scores (SAT, ACT, other). Unofficial copies of standardized test score reports will be
8. Current documentation of a learning disability that includes evaluation reports, I.E.P. and/or 504 plan, etc.
(Applicants should note that ADD/ADHD alone is not considered a learning disability. Eligible candidates
with ADD/ADHD must also provide documentation of a specific learning disability).
All application materials must be submitted in one packet. Selection Process
The Anne Ford and Allegra Ford Scholarship Committee, comprised of members of NCLD’s Board of Directors, Professional Advisory Board and distinguished friends, will make the final selection in Spring 2011. Scholarship Requirements Anne Ford and Allegra Ford Scholars are required to submit annual updates detailing their progress in school
and offering insight about their academic and personal growth. The $10,000 scholarship will be paid in four yearly installments of $2,500. Scholars must submit proof of course registration to receive their first
installment. To continue receiving payments, scholars must provide proof of course registration for each ensuing semester and documentation of passing grades (transcripts).
A completed application packet (including ALL application materials) should be sent to: Anne Ford and Allegra Ford Scholarship National Center for Learning Disabilities 381 Park Avenue South, Suite 1401
New York, NY 10016-8806 For further information please contact: Please note, any materials submitted as part of the application process will not be returned. The Anne Ford and Allegra Ford Scholarship 2010-2011 National Center for Learning Disabilities Checklist
Use this checklist to keep track of the items you need for your Anne Ford and Allegra Ford Scholarship application: APPLICATION REQUIREMENTS
Application (form available online at http://www.ncld.org/about-us/scholarships-aamp-awards/the-
Personal Statement – either written essay or video/audio tape.
Resume (including extracurricular activities, community involvement, work experience, hobbies and/or
High school transcript (official or unofficial).
Three (3) letters of recommendation (at least one from a teacher).
Financial statement (see page 7 of application).
Standardized test scores (SAT, ACT, other). Unofficial copies are acceptable.
Most recent documentation of a learning disability.
All application items must be postmarked no later than December 31, 2010 Incomplete or late application packets will not be reviewed. All application materials must be submitted in one packet. The Anne Ford and Allegra Ford Scholarship 2010-2011 National Center for Learning Disabilities Application Completed application packet must be postmarked no later than December 31, 2010 APPLICANT INFORMATION Name:
Date of Birth: / / check one: □ male □ female (month) (day) (year)
Social Security Number: - - Mailing Address: Home Phone: ( ) - Cell Phone: ( ) - U.S. Citizen* □ Yes □ No Email: *Applicants must be current US citizens. If you have questions about your eligibility for this award, send your inquiry to AFScholarship @ncld.org
PARENT/GUARDIAN INFORMATION Name(s) : Mailing Address (if different than above):
Check all that apply: □ parent □ legal guardian
□ other relative (specify)____________ □ other (specify)_____________
Home Phone (if different than above): ( ) - Cell Phone: ( ) - Email: SCHOOL HISTORY High School(s): Middle School(s): Primary School(s):
Unweighted grade point average (GPA) _____________ (as per current high school transcript)
Please check which of these learning disabilities you have:
Math Problem Solving (Dyscalculia)
Reading Fluency Skills (Dyslexia)
Executive Functioning/Organizational Skills
Listening Comprehension (and processing)
Date of initial diagnosis/classification: _____________________
Date of most recent testing: _______________________________ How did you hear about the Anne Ford and Allegra Ford Scholarship?
School Website (please specify): _______________________________________
Other (please elaborate):________________________________________
Please select the category that best describes your ethnic background (Optional)
African-American/Black (not of Hispanic origin)
Asian or Pacific Islander (includes Indian Subcontinent)
Hispanic/Latino (Spanish culture or origin, regardless of race)
White (persons not of Hispanic origin, having origins in any of the original peoples of Europe, North Africa,
Race not included above (Please specify)_______________________________________
CERTIFICATION AND AUTHORIZATION Certification: All of the information provided on this form is true and complete to the best of my knowledge. I certify that I have a documented learning disability, will be earning my high school diploma or its equivalent, and will be enrolling for
the first time in a full-time college program in the 2011-2012 academic year. I hereby authorize the National Center for Learning Disabilities, Inc. (NCLD) to use excerpts from my essay along with non-financial information from my application
for publicity and public relations purposes, provided that my confidentiality is protected. I understand that information contained in my essay may be used for research and/or publicity related activities. All application materials including essays
and transcripts become property of NCLD.
Authorization for Release of Information/Records: Applicants are responsible to arrange for transcripts and other required documentation to be submitted to NCLD. In the event that NCLD finds it necessary to seek additional information,
permission is hereby given to NCLD and its designees to contact school officials and others to request additional relevant information for use by the Anne Ford and Allegra Ford Scholarship Selection Committee and/or NCLD staff.
Signature of Applicant______________________________________ Date _______________________ Signature of Parent or Guardian_______________________________ Date ______________________
Please sign me up for NCLD’s free newsletters and e-mailings YESNO
Please be sure to “like” us on Facebook and follow us on Twitter to stay up to date with NCLD! The Anne Ford and Allegra Ford Scholarship 2010-2011 National Center for Learning Disabilities Letter of Recommendation Form All applications must be postmarked no later than December 31, 2010 Please attach this form to your written recommendation and return it to the student, in a sealed and signed envelope, so it can be included in the completed application packet.
Name of Applicant: _______________________ Date of Birth: ____ /____ /_____
Description of Anne Ford and Allegra Ford Scholarship The Anne Ford and Allegra Ford Scholarship is a $10,000 award to two high school seniors with identified
learning disabilities (LD) who will be pursuing a four-year undergraduate degrees. The Ideal Anne Ford and Allegra Ford Scholar
The ideal candidate is a high school senior who has faced the challenges of having a learning disability; is committed to completing a college degree and setting career goals; has demonstrated perseverance; embraces
new opportunities; has a well-rounded perspective shaped by experiences in school, in the community, and with family and friends; understands how LD affects his/her life and recognizes the importance of self-advocacy; believes in contributing to society in ways that increase the opportunities and potential of ALL people with
learning disabilities; and feels comfortable serving as a role model and spokesperson for others who struggle with LD.
INSTRUCTIONS Please provide the following information:
Name: Title: School/Organization: Address: Telephone: ( ) - ext. e-mail: How do you know the applicant? How long have you known the applicant?
On a separate sheet of paper or letterhead, please explain why you are recommending the applicant for the
Anne Ford and Allegra Ford Scholarship. Please use the above description to guide your comments. It would be helpful to have you reflect upon the applicant’s understanding of his/her LD, ability to self-advocate, academic
ability, tenacity/perseverance, involvement in school and community activities, leadership, and future plans.
For more information about the National Center for Learning Disabilities or the Anne Ford and Allegra Ford Scholarship, please v The Anne Ford and Allegra Ford Scholarship 2010-2011 National Center for Learning Disabilities Financial Statement
To be filled out by the applicant’s parent(s) or legal guardian
Completed application packet must be postmarked no later than December 31, 2010 Name of Applicant: _______________________ Date of Birth: ____ /____ /_____
STATEMENT OF INCOME (please select an option below) Option 1
Total income as reported on household’s (applicant and
parent/guardian) most recent federal income tax return:
Total number of exemptions claimed: ____
Option 2 Individual income reported by: Father $____________________ $____________________ $____________________ $____________________ List all members of household, ages, and relationship to applicant: Name Is this a single parent family? ( ) Yes ( ) No Number of dependent children in the family: _____________________ Number of dependent children currently attending college: _____________________
Planned year(s) of graduation: _____________________ Number of dependent children currently attending high school: _____________________ Planned year (s) of graduation: _____________________ COLLEGE INFORMATION Names of colleges to which applicant applied Accepted (circle one) Expected Tuition Costs ______________________________ Y pending $_____________________ ______________________________ Y pending $_____________________ ______________________________ Y pending $_____________________ ______________________________ Y pending $_____________________ ______________________________ Y pending $_____________________ ______________________________ Y pending $_____________________
Those candidates chosen for final review by the Selection Committee will be asked to submit copies of the most recent household federal income tax returns and W-2 forms. Please attach any additional information that you
would like to share regarding your financial situation.
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