7509 Cantrell Road, Suite 103C
Little Rock, AR 72207
501-666-8777
The Ralph G. Norman Scholarship fund was established to provide assistance to young adults with learning disabilities so
they may obtain success with independent living skills.
Ralph G. Norman Scholarship Application
Sponsored By:
Learning Disabilities Association of
Please Print or Type All blanks must be filled. If you have difficulty providing this information in typed or printed
from, you may submit an audiocassette tape. If you are unable to fit a complete response to a question on
the application, please write the section and heading and the completed response to the question on a separate
sheet of paper. Four scholarships will be awarded, each in the amount of $2,000.00
This is available ONLY to current residents of
Please attach the following, each item below must be included
on your application or your application will not be considered!
1. A documentation of your disability by one of the following:
A copy of your School IEP________
A copy of a Private Professional Evaluation _________
A detailed letter from your Physician about your disability ________
2. Official transcripts of all high school and /or college courses.
3. Include a two-paragraph statement of your future educational
or career goals.
4. Two (2) letters of recommendations from an adult that can
testify to your academic abilities, personal/character, volunteer
services, and community involvement. This evaluation cannot
be from a relative
All applications materials become the property of the Learning Disabilities Association of Arkansas. Send
completed applications and attachments by April 1, 2008, (allowing 5 days for mailing) to:
Ralph G. Norman Scholarship
LDAA
7509 Cantrell Road # 103
Only the scholarship recipients will be notified by May 1, 2008
General InformationName: ___________________________________________________________ Address: _______________________________________________________ ________________________________________________________________ City: _____________________State/Zip Code__________________________ Phone: ( ) __________________________ Age: _______ Social Security Number: _____________________________ |
Are you or your family member(s) of LDAA? Yes ___________ No ___________
Name of Member: _________________________________________________
EducationName of High School from which you graduated: _________________________ Year graduated: _____________ Grade Point Average: ___________________ If you did not graduate from high school, did you receive a GED? Yes _____ No _____ |
Information on DisabilityDo you have a learning disability: Yes ______ No ________ What specific area is your learning disability: _______________________________________________________ Do you receive SSI or SSD? Yes ______ No _______ |
I certify that to the best of my knowledge and belief, all information contained in this application is true
and accurate.
(Signature) _____________________________________ (Date) _________________
Learning Disabilities Association of Arkansas
7509 Cantrell Road, Suite 103-C
Little Rock, AR 72207
501.666.8777
