Dobson Grant Application

Email Rita Kersch with any questions or For more information on the Dobson Grant. ACBI is the Indiana affiliate of the American Council of the Blind (ACB), a consumer organization which strives to increase independence, security, equality of opportunity, and quality of life for all blind and visually impaired people.

Name*
First Last
Permanent / Home Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Mobile Phone*
Email*
Are you visually impaired?*
- Yes
- No
Are you originally from Indiana?*
- Yes
- No
High School*
What high school did you attend?

Name Of High School City State
Undergraduate University
If seeking a Master’s degree in Vision Rehabilitation Therapy, from what college or university did you receive your undergraduate degree?

Name of College or University City State
Coursework Completion*
Have you completed all necessary coursework in Vision Rehabilitation Therapy in order to do your practicum/internship?
- Yes
- No
Where do you plan to do your practicum/internship?*
Name of practicum/internship site?*
Date Of Graduation*
How would this grant assist you?
How would the Dobson Grant assist you during your practicum/internship?
A letter must be e-mailed to info@acb-indiana.org by your department chair to verify completion of necessary coursework to begin your practicum/internship.

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