skip to main contentskip to main navigation
State of New Jersey Department of Human Services  
Commission for the Blind and Visually Impaired
New Jersey Helps
NJ 211 Community Resource Website
National Library Service for the blind and physically handicapped
New Jersey Housing Resource Center
NJ Family Care
New Jersey Mental Health Cares Hotline

All fields required unless otherwise noted.

Part 1: Personal InformationFirst Name: 
MI: (optional)
Last Name: 
Additional Address Information: (optional)
Zip Code:  - (optional)
Home Phone:  - -  Ext: (optional)
Cell Phone: (optional) - -
Gender:  Male Female
e-mail Address: 
Date of Birth: 
Cause of Visual Impairment: 

Part 2: Education InformationName of Current School: 
Zip Code:  - (optional)
School Contact: 
Phone Number:  - -  Ext: (optional)
Name of School You Plan to Attend in Fall 2015: 
Zip Code:  - (optional)
Major Area of Study: 
Degree Pursued: 
Date Degree Expected: 

Part 3: Financial
(For Bodensiek & Foster Scholarship Consideration)

Number in Household: 
Total Monthly Income From All Sources: 

Part 4: Essay QuestionsPlease provide a response to each of the following with a minimum of 100 and a maximum of 300 words for each section.

Essay Section One:

Who has been the most influential person in your life and why?

Words Remaining:  

Essay Section Two:

What has been the most challenging aspect of your education thus far and what have you personally done to overcome that challenge?

Words Remaining:  

Essay Section Three:

Why should you be selected for a scholarship? Please describe any academic achievements, community service activities, examples of leadership, or other personal characteristics that make you deserving of this scholarship?

Words Remaining:  

Essay Section Four: (For Bodenseik Scholarship Applicants Only)

Please describe why you decided to major in one of the following areas of study: Science, Technology, Engineering, Mathematics, or Business.

Words Remaining:  

Supporting documents are to be collected and SENT IN ONE ENVELOPE to the Scholarship Committee. Do not send any documents until you have all the materials required. Incomplete scholarship packets will not be considered.

Mail your scholarship application materials by or before the deadline of April 29, 2015 to:

Scholarship Committee
P.O. Box 47017
Newark, NJ 07101-47017
Attn: Pamela Gaston

For additional information contact:
Toll Free: 877-685-8878


Pursuant to the Open Public Records Act (OPRA), e-mail content is a matter of public record. E-mail should not be utilized for sending confidential information.  Contact information is made available to other state agencies upon request.
OPRA - Open Public Records Act NJ Home Logo
Department: DHS Home  |  DHS Services A to Z  |  Consumers & Clients - Individuals and Families  |  Important Resources  |  Divisions & Offices  |  Commissioner & Key Staff  |  Disaster & Emergency Help & Information  |  Press Releases, Public and Legislative Affairs, & Publications  |  Providers & Stakeholders: Contracts, Legal Notices, Licensing, MedComms  |  Get Involved with DHS!  |  Notice of Non-Discrimination  |  Taglines for Language Services
Statewide: NJHome  |  Services A to Z  |  Departments/Agencies  |  FAQs
Copyright © State of New Jersey, 1996 - 2008