Ann Arbor CIL John Weir Academic Scholarship
APPLICATION FORM

The Ann Arbor Center for Independent Living (Ann Arbor CIL) awards the annual John Weir Academic Scholarship to outstanding students with disabilities. One-time scholarships range from $200 - $500.

Eligible students must:
• Be a high school senior graduating with the class of 2019;
• Have a significant disability of any kind – for example, physical, visual, developmental, cognitive, hearing, learning, emotional, or other;
• Live in Washtenaw, Livingston, or Monroe County, Michigan; and
• Plan to attend a 2- or 4-year college, university or a trade school

Questions?
Please contact Anna Dusbiber, LLMSW, Ann Arbor CIL Youth Services Manager, at (734) 971-0277 x 17 or anna@aacil.org.

Application Form Instructions
INSTRUCTIONS:
1) Fill in (by yourself or with the assistance of another person) this application form.
2) On a separate sheet of paper, answer each essay question in 300 words or less in essay/paragraph format.
3) Obtain one letter of recommendation from a teacher or a school counselor.
4) Submit this form
5) Mail your essays and recommendation letter to:

Ann Arbor CIL, John Weir Scholarship
Attn: Anna Dusbiber, LLMSW
3941 Research Park Dr.
Ann Arbor, MI 48108

DEADLINE:
All application materials MUST be postmarked by Monday, July 22, 2019.

Your Name: *
Your answer
Street Address:
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City, State, Zip *
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Telephone #:
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Email Address:
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High School:
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Grade Point Average:
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County:
Name of Teacher/Counselor Submitting Reference Letter:
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High School Telephone Number:
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Names of colleges, universities, or trade schools to which you have applied:
Your answer
Names of colleges, universities, or trade schools where you have been accepted:
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