STATE UNIVERSITY SYSTEM OF FLORIDA

2013-2014

THEODORE R. AND VIVIAN M.

JOHNSON SCHOLARSHIP*

 

 

IMPORTANT:  READ AND RETAIN A COPY FOR YOUR RECORDS

 

TO BE SENT TO UNIVERSITY (IES) IS: MAY 15, 2013

 
*This program is contingent upon annual funding by the Theodore R. and
Vivian M. Johnson Scholarship Foundation, Inc. (a/k/a the Johnson Scholarship
Foundation) and matching funding by the Florida Legislature.

The Johnson Scholarship, funded by the Johnson Scholarship Foundation, is a competitively awarded program which is available to undergraduate students with disabilities with financial need who enroll in a State University System of Florida (SUS) institution.  You must adhere to the following application guidelines in order to qualify for full consideration.

ALL APPLICANTS

In order to demonstrate financial need, all applicants must complete a 2013-2014 Free Application for Federal Student Aid (FAFSA) or Renewal FAFSA form, and mail it to the appropriate address as indicated on the FAFSA form.  To receive full consideration, the FAFSA should be mailed or completed on-line no later than April 15, 2013.

INITIAL APPLICANTS MUST:
Provide an official current transcript (not a photocopy) which documents a cumulative grade point average of at least 2.0 (on a 4.0 scale) on all credits.  High school students who are applying for the first year of college should submit a current high school transcript.

Provide documentation of the nature and/or extent of a disability.  The disability must be in one or more of the following classifications:  hearing impairment, physical impairment; specific learning disability; speech/language impairment; visual impairment; or other impairment.  Appropriate documentation includes, but is not limited to, either a recent psychological evaluation used to determine eligibility for exceptional student services, school/medical records, certification by the Division of Blind Services, or a Vocational Rehabilitation eligibility determination.  Documentation provided must meet the guidelines require by the institution in which the student is enrolled.   Students must contact the University Office of Student Disability Services for clarification as to what is required.

Gain admission as a first-time-degree-seeking undergraduate student into a State University System of Florida (SUS) institution.

Have a demonstrated financial need (determined from FAFSA information).

Be determined to be Florida Residents for Tuition Purposes, based upon 1009.21, Florida Statutes.

FIRST TIME APPLICANTS MUST SUBMIT THE FOLLOWING:

 

RENEWAL APPLICANTS MUST:
Continue to have financial need and adhere to minimum enrollment, progress, and grade point average requirements of the program, plus:

Note:  Former out-of-state Scholarship recipients who are eligible may continue to seek renewal.  Florida residency for tuition purposes is required for all new applicants awarded Fall 2007 and beyond.

APPLICATION PROCEDURES:
If you apply for admission at more than one SUS institution, submit completed Johnson Scholarship application materials to each university.  The application should be sent to the contact person listed at the end of this form.

Applications, disability documentation, personal statements, letters of reference, and an official transcript must be received by the institution(s) no later than May 15, 2013.

NOTIFICATION

All applicants will be notified of their status as Johnson Scholarship recipients, alternate award candidates, or as students who were not selected.  Notification letters will be mailed in July to the permanent address which is specified on the application forms. 

IF SELECTED, RECIPIENTS MUST:
Complete and return an acceptance form by the date specified on your notification letter.  Failure to return the acceptance form by the specified date will result in forfeiture of the award.

First-time recipients must participate in a Johnson Scholarship orientation.

Complete a minimum of nine (9) credit hours each semester.

Adhere to the minimum 2.0 cumulative grade point average requirement of this program.

Apply for renewal consideration for each academic year in which you desire the award.  Johnson Scholarship recipients may qualify for the award for up to twelve (12) semesters of undergraduate study.

AWARD PAYMENT

After verification of enrollment, the university will disburse the award on a prorated basis each academic term to eligible Johnson Scholarship recipients.  The dollar amount of the 2013-2014 awards is contingent upon the level of funding from the Johnson Scholarship Foundation and the Florida Legislature. 

FOR ADDITIONAL INFORMATION:
Call or write the appropriate university representative listed on the last page.

 

State University System of Florida Johnson Scholarship
Funded by The Johnson Scholarship
University Contacts

Submit a completed 2012 – 2013 Johnson Scholarship application form and supporting materials to the appropriate contact(s) listed below:

Dr. Danette G. Saylor, Director
Center for Disability Access and Resources
Florida A&M University
667 Ardelia Court Tallahassee, Florida  32307 Telephone: 850-599-3180
TDD: 850-561-2783
Fax:  850-561-2513
E-mail:  danette.saylor@famu.edu 

 

Ms. Myrna Pagan-Ubides, Assistant Director
Student Disability Services
University of Central Florida
Ferrell Commons 185
P.O. Box 160161
Orlando, Florida 32816-0161
Telephone:  407-823-2371
TDD:  407-823-2116
E-mail:  Myrna.Pagan-Ubides@ucf.edu

 
Ms. Nicole Rokos, Director
Office for Students with Disabilities
Florida Atlantic University
Post Office Box 3091
777 Glades Road SU 80, Room 133
Boca Raton, Florida 33431-0991
Voice Ph.: (561) 297-3880
TDD Ph.: (561) 297-0358
Nrokos@fau.edu
  

Mr. Jim Gorske, Director
Disability Resource Center
University of Florida
Building 0020 (Reid Hall)
Post Office Box 114085
Gainesville, Florida  32611-4085
Telephone: 352-392-8565
TDD:  352-392-3008
E-mail:  jimg@dso.ufl.edu www.dso.ufl.edu/drp/
 
Ms. Cori Bright
Office of Adaptive Services
Florida Gulf Coast University
10501 Ben Hill Griffin Parkway
Fort Myers, Florida 33965-6565
V: (239) 590-7956
TTY: (239) 590-7930
CBright@fgcu.edu
  
Dr. Kristine Webb, Director
Disability Resource Center
University of North Florida
Honors Hall Building Bldg 10 Room 1201
4567 St. Johns Bluff Road, South
Jacksonville, Florida 32224-2645
TDD/V Ph.: (904) 620-2769
Kwebb@unf.edu; Rlee@unf.edu
 
Amanda L. Niguidula, MPA
Disability Resource Center
Florida International University
1120 SW 8 Street, GC 190
Miami, Florida 33199
TDD: (305) 348-3852
Voice Ph.: (305) 348-3532
garciaj@fiu.edu
  

Dr. David A. Owens
ADA Consultant
Office of Diversity and Equal Opportunity
University of South Florida
4202 East Fowler Avenue, ADM 172
Tampa, Florida   33620-6150
Telephone:  813-974-8616
Fax: 813-974-4375
E-mail:  dowens@usf.edu
 
Ms. Bea Awoniyi
Assistant Dean of Students
Florida State University
Director of Student Disability Resource Center
97 Woodward Avenue, South
108 Student Services Building
Tallahassee, FL 32306-9566
Voice Ph.: (850) 644-9566
TDD.: (850) 644-9566
bawoniyi@admin.fsu.edu
  
Dr. Lusharon Wiley
Associate Dean of Students
Student Disability Resource Center
University of West Florida
11000 University Parkway
Building 21/130
Pensacola, Florida 32514
Voice Ph.: (850) 474-2161
lwiley@uwf.edu
 
Mr. Christopher Pantzis, Director
Student Disability Services
New College of Florida
5800 Bayshore Road/PKV100
Sarasota, Florida 34243
Voice Ph.: (941) 359-4254
Pantzis@ncf.edu
  

State University System of Florida
Johnson Scholarship
funded by Johnson Scholarship Foundation
 2013 – 2014 Application Form

 

This form and supporting application materials must be received by the appropriate State University System of Florida (SUS) institution no later than May 15, 2013.  Incomplete applications will not be considered.  If you choose to apply to more than one SUS institution, you must submit complete application materials to each.  Addresses are listed at the end of this form.

 

All applicants must also complete a 2012 – 2013 Free Application for Federal Student Aid (FAFSA) form or Renewal FAFSA form on-line or mail it to the address indicated on the FAFSA form  by April 15, 2013 in order to receive full consideration. 

 

PLEASE PRINT OR TYPE

                      

CHECK ALL DISABLING CONDITION(S) THAT APPLY:

Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder.  A chronic condition manifested by hyperactive and impulsive behavior, significant symptoms of inattention, or both.  The behavior and symptoms have a significant impact on cognitive ability and academic functioning.
Autism Spectrum Disorder.  Disabilities characterized by an uneven development profile and a pattern of qualitative impairments in social interaction, communication difficulties, and/or the presence of restricted repetitive or stereotyped patterns of behavior, interests, and activities. These characteristics may manifest in a variety of combinations and range from mild to severe.
Blind or Low Vision.  Disabilities in the structure and function of the eyes as    manifested by at least one of the following: visual acuity of 20/70 or less in the better eye after the best possible correction, a peripheral field so constricted that it affects one’s ability to function in an educational setting, or a progressive loss of vision that may affect one’s ability to function in an educational setting. Examples include, but are not limited to, cataracts, glaucoma, nystagmus, retinal detachment, retinitis pigmentosa, and strabismus.
Deaf/Hard of Hearing.  A hearing loss of thirty (30) decibels or greater, pure tone average of 500, 1000, 2000, and 4000 hertz (Hz), unaided, in the better ear. Examples include, but are not limited to, conductive hearing impairment or deafness, sensorineural hearing impairment or deafness, high or low tone hearing loss or deafness, and acoustic trauma hearing loss or deafness.
Orthopedic Disability.  A disability of the musculoskeletal system, connective tissue, or neuromuscular system. Examples include, but are not limited to, cerebral palsy, absence of some body member, clubfoot, nerve damage to the hand or arm, cardiovascular aneurysm (CVA), head injury or spinal cord injury, arthritis or rheumatism, epilepsy, intracranial hemorrhage, embolism, thrombosis (stroke), poliomyelitis, multiple sclerosis, Parkinson’s disease, congenital malformation of brain cellular tissue, and physical disabilities pertaining to muscles or nerves, usually as a result of disease or birth defect, including, but not limited to, muscular dystrophy and congenital disorders.
Psychological, Emotional, or Behavioral Disability.  Any mental or psychological disability including, but not limited to, organic brain syndrome, emotional or mental illness, or attention deficit disorders.
Speech/Language Disabilities.  Disabilities of language, articulation, fluency, or voice that interfere with communication in academic settings, employment preparation/training or social interaction on campus. Examples include, but are not limited to, cleft lip or palate with speech disabilities, stammering, stuttering, laryngectomy, and aphasia.
Specific Learning Disability.  A disability in one or more psychological or neurological processes involved in understanding or using spoken or written language. Learning disabilities may be manifested in listening, thinking, reading, writing, spelling, or performing arithmetic calculations. Examples include dyslexia, dysgraphia, dysphasia, dyscalculia, and other specific learning disabilities in the basic psychological or neurological processes. Such disabilities do not include learning problems that are due primarily to visual, hearing, or motor disabilities, to intellectual disabilities, to psychiatric or emotional disabilities or to an environmental deprivation.
Traumatic Brain Injury.  An injury to the brain, not of a degenerative or congenital nature but caused by an external force, that may produce a diminished or altered state of consciousness, which results in impairment of cognitive ability or physical ability and functioning.
Other Health Disabilities.  Any disability not identified in this subsection deemed by a disability professional to make completion of the requirement impossible.

HAVE YOU BEEN ADMITTED TO THE UNIVERSITY OF WEST FLORIDA? (check one)      

2013 - 2014 ACADEMIC LEVEL:
(check one)                    


SELECTIVE SERVICE REGISTRATION


         
         
                members of Reserve and National Guard units who are not on active duty).
         
         
         
                permanent resident of the Trust Territory of the Pacific Islands (Palau).

RESIDENCY FOR TUITION PURPOSES STATUS (check one):

CITIZENSHIP STATUS (check one):
         

         
               

ETHNIC ORIGIN (check one*):
                                   


(*Failure to disclose your ethnic origin will not disqualify your application)

Initial applicants must submit to the appropriate University:

Renewal applicants must submit the following to the appropriate University:

I certify that I have read and understood the conditions for participation in this program.  The information I am supplying in this application is true, complete, and correct.  By signing the form, I also grant permission for information pertaining to my financial need, and all supporting application materials, to be released by the appropriate university to the Board of Governors Office for Academic and Student Affairs and Johnson Scholarship Foundation.  NOTICE:  If you purposely give false information, you may be subject to fine, or imprisonment, or both under 827.06, F.S.

 

      
(Signature-type name & email address if submitting electronically)   System date will be used as the official date of submission.       

SUBMIT APPLICATION MATERIALS TO THE APPROPRIATE UNIVERSITY CONTACT
PERSON(S) LISTED AT THE END OF THE SCHOLARSHIP INSTRUCTIONS.

[UWF ONLY]