The Ralph G. Norman Scholarship Recommendation

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SUBMITTING YOUR APPLICATION:

Completed applications must be submitted by March 30, 2025.

APPLICATION REQUIREMENT CHECKLIST:

Please provide the following information. 

1. Scholarship Application Form (below)

2. Most recent documentation of your learning disability:

   1. A copy of Professional Evaluation indicating your learning disability, OR

   2. A letter from a qualified professional certifying your learning disability (psychologist, psychological examiner, or speech-language pathologist).

3. Personal Statement: Include a brief essay (less than 1,000 words) about how your disability has impacted your life and about future educational and career goals. Applicants may also elect to submit a 2-4 minute video or audio taping as an alternative to the essay.

4. Transcript of all high school and/or college courses.

5. Two letters of recommendation from adults that can testify to your academic abilities, personal character, volunteer services, and community involvement. These letters should be from a teacher, coach, counselor, or community member – not a relative. Send your recommending people to this URL to submit their recommendations directly: https://lda-arkansas.org/ralph-g-norman-scholarship-recommendation-submissions/

6. Signed media and signature page.

Please e-mail info@ldarkansas.org (Attention: Scholarship Chair) if you have questions regarding the application process.

Ralph G. Norman Scholarship Application Form

Please type in the following blanks. All blanks must be filled. Applications must be submitted by March 30,2025. Recipients will be notified in the spring of 2025.

GENERAL INFORMATION

Applicant's Name*Applicant's Complete Address (street/city/state/zip code)*Home PhoneCell Phone*Email Address*Additional Contact PersonAdditional Contact Number

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EDUCATIONAL INFORMATION

High School OR Post Secondary School Currently Attending:*Year of Graduation:*School Contact Person:*Current High School or Post Secondary School's Complete Address:*Professional Evaluation: Please upload a copy of Professional Evaluation indicating your learning disability, OR a letter from a qualified professional certifying your learning disability (psychologist, psychological examiner, or speech-language pathologist).*Max. file size: 256 MB.Grades: You MUST submit a copy of your current transcript.*Max. file size: 256 MB.

College, university or other educational institution the applicant plans to attend:

Briefly describe your Educational/Career Goals and include the names of the university, two-year community college, or a vocational/technical training program that you will be applying.
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LEARNING DISABILITY INFORMATION

Please check which learning disabilities you have:*Impairment in Reading (Dyslexia)Basic Reading/Word Reading AccuracyReading Rate/Reading FluencyReading ComprehensionImpairment in Written Expression (Dysgraphia)Impairment in Mathematics (Dyscalculia)Math CalculationMath Problem SolvingOther:Personal Statement: Include a brief essay (less than 500 words) about how your disability has impacted your learning in the educational environment. You could consider any or all of the following: Classroom instruction, Tests and Quizzes, Communication, and Assignments.Disability Support Services: Include a brief essay that answers this question (less than 500 words) Based on your educational and career goals, what accommodations will you request through disability support services and how will you advocate for yourself and request the strategies that help you learn best? {You may choose to submit a 2-4 minute video in place of both essays}Upload your video here.Max. file size: 256 MB.
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PERSONAL ACHIEVEMENTS AND ACTIVITIES FORM

Part 1: Extracurricular Activities

Use this section for extracurricular activities (school clubs, sports, etc.) you have been involved in.

Part 2: Community and Work Experience

Use this section to list any community, volunteer, or work experience you have.

Part 3: Other Activities

Use this section to list any other activities you have been involved in.

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RECOMMENDATIONS

Applicants must provide at least two recommendations from adults that can testify to your academic abilities, personal character, volunteer services and community involvement. These recommendations should come from a teacher, coach, counselor or community member – not a relative.

Please enter their email addresses below. They will receive an email with a link to a form, where they may submit their recommendation on your behalf. 

Recommendation 1 Email Address

Recommendation 2 Email Address

Recommendation 3 Email Address

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MEDIA RELEASE

I hereby grant the Learning Disabilities Association of Arkansas permission to use my likeness in a photograph, my name, age, hometown, school, desired college or vocational school, and/or excerpts of my scholarship essay or my entire scholarship essay in any and all of its publications, including website entries, without payment or any other consideration. I hereby grant the Learning Disabilities Association of Arkansas permission to include the information that I am a person with a learning disability.I understand and agree that my Learning Disabilities Association of Arkansas scholarship materials will become the property of the Learning Disabilities Association of Arkansas and will be used for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.

I hereby irrevocably authorize the Learning Disabilities Association of Arkansas to edit, alter, copy, exhibit, publish or distribute all scholarship materials – excluding evaluation records, IEPs and transcripts – for purposes of publicizing the Learning Disabilities Association of Arkansas programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears.

Additionally, I waive any right to royalties or other compensation arising or related to the use of my scholarship application materials. I hereby hold harmless and release and forever discharge the Learning Disabilities Association of Arkansas from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Your Signature*Date*

MM slash DD slash YYYY

OR 

If the person signing is under the age of 18, a parent or guardian must give consent, as follows:

I hereby certify that I am the parent or guardian of, named above, and do hereby give my consent without reservation to the foregoing on behalf of this person.

Signature of Parent or Guardian (If under the age of 18):Date

MM slash DD slash YYYY

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SIGNATURE

I certify to the best of my knowledge, and believe all information contained in this application to be true and accurate. I certify that I have a documented learning disability, have earned or will be earning a high school diploma or its equivalent, and will be enrolling at a university, community college, or vocational/technical training program in Fall Semester 2025.

In providing this scholarship, LDAA does not discriminate on the basis of race, sex, national origin, religion, disability, age, sexual orientation, or gender identity.

Your Signature*Date*

MM slash DD slash YYYY
Signature of Parent or Guardian (If under the age of 18):Date

MM slash DD slash YYYY

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