Scholarship Form Apply now Name Email Address Date of Birth Please list, if any, financial aid you have applied for or are receiving: Please list schools attended and degrees recieved: To which of schools optometry have you applied? Which schools have accepted you? Which school do you plan to attend? Explanation of Interest in Optometry (300 words or fewer) Previous applicants may reuse prior responses. Need for Scholarship (100 words or fewer) Previous applicants may reuse prior responses. College Transcript Optometry School Transcript Scholarship Interviews - Optometrist Schlarship Interviews - Educator Consent I do affirm that it is my intent to return to Kansas following graduation from optometry school in order to engage in the practice of optometry. I understand that in order fulfill the agreement under which the scholarship was given, I will practice on year in Kansas for each annual scholarship I receive. If I do not return to Kansas to practice optometry I understand I will be required to pay back to the Kansas Optometric Foundation the full amount of the scholarship. Signature Submit
