2020 KSSB and KC Blind All-Stars Space Camp Scholarship Application
(Image above title: space rocket/shuttle)

We are pleased to announce that the Kansas State School for the Blind (KSSB) and KC Blind All-Stars (KCBAS, a non-profit that supports KSSB) are providing funds for 4 high school students (preference given to upperclassmen) from Kansas to attend Space Camp for Interested Visually Impaired Students (SCIVIS). This is a week-long camp held in Huntsville, Alabama at the U.S. Space and Rocket Center. It is a camp for students who are blind and visually impaired from the U.S. and around the world. The dates for this year's camp are September 26, 2020 to October 2, 2020. Kansas students who receive a Space Camp Scholarship may attend one of 2 camp options:
Advanced Academy or Mach III Aviation Challenge.

SCIVIS provides an exciting and experiential learning opportunity. A unique space, science and aviation curriculum is presented and teamwork is a key component during simulated space/aviation missions. All program materials are available to students in braille (both contracted and uncontracted), large print, or electronic magnification as needed. Students are encouraged to bring any handheld magnification devices they use and if the student is a cane traveler, they are required to bring their cane. Many areas of the Expanded Core Curriculum are also addressed at the camp.

More information regarding SCIVIS can be found at http://www.scivis.org/

Adult chaperones attend with students from Kansas but, because of the nature of the camp, the chaperones may not be with the Kansas students the entire time they are at the camp. Because of the camp structure, a certain amount of independence is required for a student to have a good camp experience. Due to these reasons, a required Life Skills checklist is attached to this application.

This three-step application process must be completed in order to qualify for a scholarship.
1. Complete the KSSB & KCBAS Space Camp Application.
2. Write a one page essay answering the following prompt: Why should you be chosen to receive a scholarship for space camp? (Please send response separately) (A rubric is at the bottom of this application)
3. Two letters of recommendation are required. These should be from the student's Teacher of Students with Visual Impairment (TSVI), and Certified Orientation and Mobility Specialist (COMS).

Application is due by March 15, 2020. Applications may be submitted online, by mail, or emailed to the address below. We will accept applications in braille, electronically, or in print.

If sending a paper copy or hard copy braille, please send to:
Kansas State School for the Blind
Attn: Space Camp Scholarship Committee c/o Judy Imber
1100 State Ave.
Kansas City, KS 66102

Questions concerning SCIVIS and this application process may be conveyed to the following contact person:
Pam Arbeiter

If you are pre-selected to receive the KSSB/KCBAS Space Camp Scholarship, you will be notified in April 2020. The scholarship covers the cost of the camp, travel and food during travel. Please note further paperwork, including a waiver of liability, will need to be completed by parents and students upon acceptance of the scholarship.
Email address *
Student's name *
Your answer
Student's birthdate *
Your answer
Nature of visual impairment *
Your answer
Student's grade level *
Your answer
Student's school district *
Your answer
Parent's or guardian's name(s) *
Your answer
Home address *
Your answer
Home phone number *
Your answer
Work phone number *
Your answer
Check which camp you would like to attend (for more information about the specific choices for camp, visit www.scivis.org/programs) *
Teacher of Students with Visual Impairments (TSVI) name, phone number & email *
Your answer
Orientation & Mobility Specialist's name, phone number & email *
Your answer
Eligibility Considerations *
Student has ability to read, speak and understand English with fluency
Student has the ability to quickly learn new technology
Student has at least "C" average academic ability
Student is able to miss one week of his/her regular school program
Student is willing to interact positively with peers who are blind or visually impaired
Student is willing to participate in pre-camp activities as needed
Student has parents/guardians who are willing to participate online to fill out required forms and communicate with chaperones prior to and during camp
Student commits to make up any missed schoolwork during his/her absence
Student commits to writing gracious and quality thank you letters and blog posts (to be posted on KSSB website) without repeated reminders upon return
Student commits to attempting all activities during the week at SCIVIS (some activities include SCUBA diving, high ropes activities, zip lining, rock wall climbing) Students will be screened based on medical conditions-limitations may be placed on some
Student has stayed away from home overnight without family members
Student has flown on an airplane
Independent Living Skills Checklist (if you have additional information, please share in the next question) *
Gets dressed independently
Familiar with own clothing/can arrange own outfits
Keeps clothing neat (folded or hanging)
Tie shoes/fasten buttons and zippers
Packs suitcase
Washes/styles own hair
Brushes teeth
Eye care (prosthetics)
Use feminine products without assistance
Knowledge of medical needs
Knowledge of medications
Chooses appropriate clothing for the day/weather
Packs a day bag for outing
Gets own food in cafeteria
Aware of healthy food choices
Uses utensils appropriately
Uses general dining etiquette
Opens packages (condiments, water bottles, milk cartons)
Uses human guide technique
Has independent cane skills
Politely solicits help when necessary
Asks questions
Meets new friends and maintain friendships
Displays age appropriate behavior when away from parents
Has some interest in space and academics
Can climb a ladder
Can call home
Makes own bed-including top bunk
Responds to emergency drills (get outside quickly)
Handles money
Additional information you would like the scholarship committee to consider:
Your answer
Other activities student enjoys participating in: *
Your answer
I give permission to scholarship committee to contact above listed people (TSVI, O&M specialist) in order to process the scholarship application during consideration of scholarship recipients. *
Essay Requirement
Please write up to one page, answering the following prompt-you may submit this separately by mail or email: What makes you a good candidate for a scholarship to attend space camp? Please use the Space Camp rubric located here:

By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. (Initials from parent or guardian unless student is over 18 years of age).
Your answer
images of Kansas State School for the Blind logo, Space Camp for Interested Visually Impaired Students logo and KC Blind All-Stars logo
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