Roeder Scholarship Application

Roeder Scholarship Form

Fields marked with an asterisk (*) are required.

  • Gender * Required
  • Address * Required
  • I will be attending school
  • I will be working
  • Do you read Braille
  • A recently signed letter on a single page of official stationery from an optometrist, ophthalmologist, state or private agency for the blind certifying you are legally blind) Please do not send your complete medical report. The letter must clearly state your corrective visual acuity in your better eye is 20/200 or less or you have a visual field less than 20 degrees.
  • Upload Three letters of reference using each of the three "Browse" buttons below. One must be a character reference and preferably one from an employer.