[Nfbv-fairfax] VLEI Scholastic Grant Application for vision impaired students

[John Bailey]

Thanks to Lion Rodney Neely for passing the application (attached) along to us.


Joe Lipomi Memorial SCHOLASTIC GRANT APPLICATION
Purpose: The Virginia Lions Eye Institute Joe Lipomi Memorial Scholastic Grants are given to qualified
visually handicapped individuals and sponsored by individual Lions clubs of District 24-A. The overriding
objectives of the grants are to enhance to potential for the recipients to achieve an independent, self
supporting life. Grant dollars may be used for assistive devices, educational/training expenses, and
other expenses associated with the objectives of the Grants and the recipients.
Qualifications:
1) Visual acuity must be limited to 20/70 or less best corrected in the best eye or a binocular visual field of
30 degrees or less. Sight must be documented by an eye care professional (Ophthalmologist or
Optometrist).
2) Sponsorship by a Lions Club with a recommendation for the sponsoring club. VLEI will find a
sponsoring club if the applicant needs that service.
3) The Grant Application must be accompanied by a separate Essay explaining why the grant is needed
and how the funds will be used. It is helpful if the applicants "introduce themselves" and describe their
interests and objectives for the future. Other than 1) above, the Essay is the only information the Board of
Trustees has to distinguish between applicants when the number of applications Exceed the annual
budget for Grants. First time applicants receive priority over applications from those who have received
previous Grants.
Required Personal Data (SSN may be ATTACHED on a plain sheet without name if desired)
Name: SSN:
Address: Phone:
Email:
(Legible to be useful)
Visual Disability:
Visual acuity with best correction: Right eye Left eye
Visual field (binocular) Degrees
Ophthalmologist/Optometrist evaluation with signature / phone (may be attached)
Sponsoring Lions Club:
Application Date _____________
Completed applications must be mailed / emailed to Lion Elden Wright, 9310 Ashmeade Dr.,
Fairfax, VA 22032 and must arrive by 7 December. Approved applications will be notified in late
December. . The grants will be presented at the Lions Winter Conference in February. Details will be
announced when finalized. Questions (?) ewright22 at aol.com (subject: Scholastic Grant) or 703-323-
6915
Print Form
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