Lavelle Leaders Award Application Form

Proof of sponsorship by a vision-specific state agency such as the NYS Commission for the Blind (NYSCB), CT Bureau of Education and Services for the Blind (BESB), or NJ Commission for the Blind and Visually Impaired (CBVI) OR letter from a medical eye care provider indicating legal blindness will suffice.

Applications must include an essay in Word format, 14 font, no longer than 3 pages in response to the following prompt: “Share Your Strength”. Drawing from your personal experience, describe how, and in what capacity, you developed leadership skills, and how such efforts have made a significant impact on your community. Be sure to include any obstacles you encountered and how you handled them. Feel free to mention any individual (mentor, teacher, relative) who might have had an influence on your development as a leader.

Two letters of recommendation from individuals who have worked with the applicant in a school, work, or civic capacity must be sent from Recommenders directly to Kate Morris ([email protected]) no later than May 31st. Letters of recommendation received from the applicant's email address will not be accepted. It is the Applicant's responsibility to request and track these letters. Please indicate the names and titles of individuals who will submit recommendations, below.

1 - The Lavelle Fund reserves the right to change awards, amounts and eligibility criteria without prior notice. The Fund further reserves the right to not issue any Leader Awards in any given year if submissions do not meet our standards.

2 - Information collected during the application process is shared only with the award selection committee for review and awarding purposes, and the Fund’s Controller to distribute the financial award to award winners.

3 - To track scholarship tuition reimbursement payments and to ensure that each awardee only receives one scholarship, the Lavelle Fund will permanently retain the names and details of its annual scholarship winners. Additional electronic applicant records will be purged after the scholarship award selection process has concluded.

4 - Scholarship award recipients authorize that their name and image may be shared publicly in Lavelle Fund communications and agree to participate in marketing activities as appropriate.

5 - The Lavelle Fund is not required to report scholarship award funds to U.S. residents as income, either to the IRS or the student recipient, or to withhold taxes from scholarship payments. Federal tax laws consider it the student’s sole responsibility to know when income is taxable or not, and to report income accordingly on his or her personal tax returns.

A copy of this submission will be automatically sent to the applicant's email address provided above.