<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=us-ascii">
<meta name="Generator" content="Microsoft Word 15 (filtered medium)">
<style><!--
/* Font Definitions */
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri",sans-serif;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:#954F72;
text-decoration:underline;}
span.EmailStyle17
{mso-style-type:personal;
font-family:"Calibri",sans-serif;
color:windowtext;}
span.EmailStyle18
{mso-style-type:personal-reply;
font-family:"Calibri",sans-serif;
color:#1F497D;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]-->
</head>
<body lang="EN-US" link="#0563C1" vlink="#954F72">
<div class="WordSection1">
<p class="MsoNormal"><span style="color:#1F497D">Thanks to Lion Rodney Neely for passing the application (attached) along to us.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Joe Lipomi Memorial SCHOLASTIC GRANT APPLICATION
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Purpose: The Virginia Lions Eye Institute Joe Lipomi Memorial Scholastic Grants are given to qualified
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">visually handicapped individuals and sponsored by individual Lions clubs of District 24-A. The overriding
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">objectives of the grants are to enhance to potential for the recipients to achieve an independent, self
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">supporting life. Grant dollars may be used for assistive devices, educational/training expenses, and
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">other expenses associated with the objectives of the Grants and the recipients.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Qualifications: <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">1) Visual acuity must be limited to 20/70 or less best corrected in the best eye or a binocular visual field of
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">30 degrees or less. Sight must be documented by an eye care professional (Ophthalmologist or
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Optometrist). <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">2) Sponsorship by a Lions Club with a recommendation for the sponsoring club. VLEI will find a
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">sponsoring club if the applicant needs that service.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">3) The Grant Application must be accompanied by a separate Essay explaining why the grant is needed
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">and how the funds will be used. It is helpful if the applicants "introduce themselves" and describe their
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">interests and objectives for the future. Other than 1) above, the Essay is the only information the Board of
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Trustees has to distinguish between applicants when the number of applications Exceed the annual
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">budget for Grants. First time applicants receive priority over applications from those who have received
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">previous Grants. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Required Personal Data (SSN may be ATTACHED on a plain sheet without name if desired)
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Name: SSN: <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Address: Phone: <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Email: <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">(Legible to be useful) <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Visual Disability: <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Visual acuity with best correction: Right eye Left eye
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Visual field (binocular) Degrees
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Ophthalmologist/Optometrist evaluation with signature / phone (may be attached)
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Sponsoring Lions Club: <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Application Date _____________ <o:p>
</o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Completed applications must be mailed / emailed to Lion Elden Wright, 9310 Ashmeade Dr.,
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Fairfax, VA 22032 and must arrive by 7 December. Approved applications will be notified in late
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">December. . The grants will be presented at the Lions Winter Conference in February. Details will be
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">announced when finalized. Questions (?) ewright22@aol.com (subject: Scholastic Grant) or 703-323-
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">6915 <o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Print Form<o:p></o:p></span></p>
</div>
</body>
</html>