Education Scholarship Application
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NAACP Scholarship Information Packet
APPLICATION INSTRUCTIONS Application forms and required documents must be postmarked on or before the last Friday in the month of March. GENERAL INSTRUCTIONS: Please read the following information before completing this application. 1. You must fully complete a separate typed application for each scholarship for which you are applying. If you need more than one application, you must photocopy the enclosed application. 2. Complete and attach the title page and all supporting documents to each complete application. FOR EXAMPLE: IF YOU ARE APPLYING FOR THE HBCU SCHOLARSHIP FUND AND THE ROY WILKINS SCHOLARSHIP, TWO APPLICATIONS MUST BE SUBMITTED
WITH THE HBCU SCHOLARSHIP FUND YOU SHOULD ATTACH: A. Title page for the HBCU Scholarship Fund B. Three recommendation letters C. An official transcript D. Financial verification information E. Evidence of full-time enrollment F. One page essay THEN, A SEPARATE TYPED APPLICATION MUST BE SUBMITTED FOR THE ROY WILKINS SCHOLARSHIP; WITH IT YOU SHOULD ATTACH: A. Title page for the Roy Wilkins Scholarship B. Two recommendation letters C. An official transcript D. Financial verification information E. College/University Acceptance Letter F. Verification of NAACP membership G. One page essay All applications must include the required materials. The UNCF/NAACP will not be responsible for making duplicate copies of applications and/or required materials. If required materials are not included with each separate application, your application will be considered incomplete. All incomplete applications will be disqualified. Send to: The United Negro College Fund Scholarships & Grants Administration 8260 Willow Oaks Corporate Drive Fairfax, VA 22031 ATTN: Kimberly Hall Phone: 703.205.3400 www.uncf.org
Scholarship recipients will be listed on the NAACP web page (www.naacp.org) by MidJuly of each year. Only scholarship recipients will receive official notification.
-1–
TITLE PAGE
THE EARL G. GRAVES SCHOLARSHIP Please sign and attach this page to completed typed application
ELIGIBILTY CRITERIA •
Applicant must be a junior or senior Business major enrolled in an accredited college or university in the United States; or a graduate student enrolled or accepted to a master’s or doctoral program within a Business school at an accredited college or university in the United States (Applicant may apply during their sophomore year).
•
Applicant must currently be in good academic standing and making satisfactory progress toward an undergraduate or graduate degree.
•
Applicant must be a full-time student.
•
Applicant must be in the top 20% of his/her class
•
Applicant need not demonstrate a financial need. Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: $5,000 REQUIRED MATERIAL Please submit the following with your completed TYPED application: •
Three letters of recommendation (other than relatives): One personal reference, two academic references from the business school of the accredited college (academic letters must be on official letterhead).
•
Recent official college transcript.
•
Evidence of full-time enrollment. If selected, verification of enrollment must be furnished.
•
One page essay (see section H of the “Applicant Personal Information Form”) Have you included?
One Page Essay ___
Three Recommendations ___
Transcript ___
Verification of Enrollment ___
Student Signature: ______________________________________________ Date: __________________
-2–
TITLE PAGE
THE AGNES JONES JACKSON SCHOLARSHIP Please sign and attach this page to completed typed application
ELIGIBILTY CRITERIA •
Applicant must be a current member of the NAACP. Applicant must submit a copy of their NAACP membership card or membership application to verify membership.
•
Applicant must be a citizen of the United States and be enrolled in an accredited college or university in the United States.
•
Undergraduate applicant must be a full-time student. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester. Graduate applicant may be a full- or part-time student.
•
Graduating high school seniors and undergraduate students must possess a grade point average of 2.5 (C+) on a 4.0 system. Graduate students must possess a 3.0 (B) average on a 4.0 system.
•
Applicant must demonstrate financial need based on the following scale:
Persons in Family 1 2 3 4
Income Limits $ 14,355 $ 19,245 $ 24,135 $ 29,025
Persons in Family 5 6 7 8
Income Limits $ 33,915 $ 38,805 $ 43,695 $ 48,585
•
Applicants who exceed the income limitations may apply and compete for a certain amount set aside for those students.
•
Renewals will not be automatic. Recipients will have to compete for the renewal of their scholarships. Additional information, such as the most recent cumulative grade point average, NAACP activities, as well as other civil rights activities, and academic awards will be considered. The renewal award may be reduced or denied based on insufficient NAACP activities.
•
Applicants for the Agnes Jones Scholarship must not have reached the age of 25 by the application deadline. Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: Undergraduate: $1,500
Graduate: $2,500
REQUIRED MATERIALS Please submit the following with you completed TYPED application: •
Three letters of recommendation (other than relatives): One personal reference, one academic reference and one NAACP reference. -3–
TITLE PAGE
The NAACP letter of recommendation should be from the Advisor of the Youth Council or College Chapter; member of the Executive Committee of the Branch, Youth or College Chapter; member of the National Board; SCF Trustees; member of the National Youth Work Committee; or NAACP employee, except for those persons who are current members of the Scholarship Committee. Persons submitting letters must specify title and use NAACP letterhead. •
Recent official transcript of grades (high school or college).
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
Evidence of full-time enrollment or application for full-time enrollment for undergraduate applicants (verified by a copy of the application for enrollment; acceptance letter, or letter from the university verifying status). If selected, verification of enrollment must be furnished.
•
Evidence of NAACP membership, verified by a copy of membership card or receipt of membership.
•
One page essay (see section H of the “Applicant Personal Information Form”)
Have you included? Transcript ___ Three Recommendations ___
Verification of NAACP Membership ___ Verification of Enrollment ___
Student Signature: ____________________________________________
Financial Information ____ One Page Essay ____
Date: ___________________
-4-
TITLE PAGE
THE HBCU SCHOLARSHIP FUND Please sign and attach this page to completed typed application
ELIGIBILITY CRITERIA •
Applicant must be a current student or incoming freshman at a Historically Black College or University.
•
Applicant must be a citizen of the United States and apply to be accepted at an accredited college (excluding proprietary schools) in the United States.
•
Applicant must be a full-time student. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester.
•
Applicants must possess a cumulative grade point average of 2.5 (C+) on a 4.0 system.
•
NAACP membership and participation is highly desirable.
•
Applicant must demonstrate financial need based on the following scale:
Persons in Family 1 2 3 4
Income Limits $ 14,355 $ 19,245 $ 24,135 $ 29,025
Persons in Family 5 6 7 8
Income Limits $ 33,915 $ 38,805 $ 43,695 $ 48,585
Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: $2,000
-5-
TITLE PAGE
REQUIRED MATERIALS Please submit the following with your completed TYPED application: •
Three letters of recommendation (other than relatives): One personal, one academic reference and one NAACP reference. The NAACP letter of recommendation should be from the Advisor of the Youth Council or College Chapter; member of the Executive Committee of the Branch, Youth or College Chapter; member or the National Board; SCF Trustees; member of the National Youth Work Committee; or NAACP employee, except for those persons who are current members of the Scholarship Committee. Persons submitting letters must specify title and use NAACP letterhead.
•
Recent official transcript of grades.
•
One page essay (see section H of the “Applicant Personal Information Form”)
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms
NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
Evidence of full-time enrollment or application for full-time enrollment. If selected, verification of enrollment must be furnished.
Have you included? Transcript____ Three Recommendations____
Verification of NAACP Membership ____
Financial Information ___
Verification of Enrollment ____
One Page Essay ___
Student Signature: ____________________________________________ Date: ____________________
-6–
TITLE PAGE
THE LILLIAN & SAMUEL SUTTON EDUCATION SCHOLARSHIP Please sign and attach this page to completed typed application
ELIGIBILTY CRITERIA •
Applicant must be an Education major and a United States citizen enrolled in an accredited college in the United States.
•
NAACP membership and participation is highly desirable.
•
Undergraduate applicant must be a full-time student. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester. Graduate students may be full or part-time students.
•
Graduating high school seniors and undergraduate students must possess a grade point average of 2.5 (C+) on a 4.0 system. Graduate students must possess a 3.0 (B) average on a 4.0 system.
•
Renewals will not be automatic. Recipients will have to compete for the renewal of their scholarship and must maintain a 2.5 GPA for undergraduates and a 3.0 for graduates to qualify for renewal. Additional information such as recent GPA, and verification of education major will be considered. Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: Undergraduate: $1,000
Graduate: $2,000
REQUIRED MATERIALS Please submit the following with your completed TYPED application: •
Two letters of recommendation from a teacher or professor in the major field of specialization. Letters must be typed on appropriate letterhead.
•
Evidence of full-time enrollment or application for full-time enrollment for undergraduate applicants (verified by a copy of the enrollment application; acceptance letter; or letter from the university verifying status). If selected, verification of enrollment must be submitted.
•
Recent official college transcript.
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
One page essay (see section H of the “Applicant Personal Information Form”)
-7–
TITLE PAGE
Have you included? Transcript____
Verification of Employment ____
Two Recommendations ___
Financial Information____
Verification of NAACP Membership ____
One Page Essay ___
For High School Seniors Only: College/University Acceptance Letter ____
Student Signature: ____________________________________ Date: ____________________________
-8 –
TITLE PAGE
THE ROY WILKINS SCHOLARSHIP Please sign and attach this page to completed typed application
ELIGIBILTY CRITERIA •
Applicant must be an entering college freshman.
•
Applicant must be a citizen of the United States and seeking enrollment in an accredited college in the United States.
•
NAACP membership and participation is highly desirable.
•
Undergraduate applicants must be full-time students. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester.
•
Applicant must possess a grade point average of at least 2.5 (C+) on a 4.0 system.
•
The Roy Wilkins Scholarship is not renewable. Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: $1,000 REQUIRED MATERIALS Please submit the following with your completed TYPED application: •
Two letters of recommendation (other than relatives): One personal reference and one academic reference.
•
Current official transcript of grades (high school).
•
Copy of application for admission or letter of acceptance from college or university.
•
Copy of NAACP membership card or receipt of membership.
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
One page essay (see section H of the “Applicant Personal Information Form”)
-9-
TITLE PAGE
Have you included? Transcript ____ Two Recommendations ____
Verification of NAACP Membership ____
College/University Acceptance Letter ___
Financial Information ____
One Page Essay ___
Student Signature: ____________________________________________ Date: ____________________
- 10 –
TITLE PAGE
THE HUBERTUS W.V. WILLEMS SCHOLARSHIP FOR MALE STUDENTS Please sign and attach this page to completed typed application
ELIGIBILITY CRITERIA •
Applicant must be a male majoring in one of the following fields: Engineering, Chemistry, Physics or Mathematical Sciences.
•
Applicant must be a citizen of the United States and be applying to or accepted at an accredited college (excluding proprietary schools) in the United States.
•
NAACP membership and participation is highly desirable.
•
Undergraduate applicant must be a full-time student. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester. Graduate applicant may be a full or part-time student.
•
Graduating high school seniors and undergraduate students must possess a grade point average of 2.5 (C+) on a 4.0 system.
•
Graduate student must possess a 3.0 (B) average on a 4.0 system
•
Applicant must demonstrate financial need based on the following scale:
Persons in Family 1 2 3 4
Income Limits $ 14,355 $ 19,245 $ 24,135 $ 29,025
Persons in Family 5 6 7 8
Income Limits $ 33,915 $ 38,805 $ 43,695 $ 48,585
Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: Undergraduate: $2,000
Graduate: $3,000
REQUIRED MATERIALS Please submit the following with your completed TYPED application: •
Two letters of recommendation from a teachers or professors in the major field of specialization. Letters must be typed on appropriate letterhead.
•
Recent official transcript of grades.
- 11 –
TITLE PAGE
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
Evidence of full-time enrollment or application for full-time enrollment. If selected, verification of enrollment must be furnished.
•
One page essay (see section H of the “Applicant Personal Information Form”)
Have you included? Transcript ____
Two Recommendations ____
Financial Information ____
Verification of Enrollment ____
Verification of NAACP Membership ____
One Page Essay ___
Student Signature: _________________________________________
Date: ______________________
- 12 -
Applicant's Social Security Number
3909
-
NAACP Scholarship APPLICANT PERSONAL INFORMATION FORM 2006-2007
To submit this application, please print in black or dark blue ink. For each multiple choice question, fill in the appropriate circle; for the essay question, you must type your response.
A. Applicant's Personal Information
1.
APPLICANT'S FULL LEGAL NAME MIDDLE
FIRST
LAST
2.
3.
GENDER MALE FEMALE
6. 7.
4.
DATE OF BIRTH
-
-
5.
SOCIAL SECURITY NUMBER
-
CURRENT SCHOOL PHONE NUMBER
-
-
E-MAIL ADDRESS
NO. & STREET ADDRESS
PERMANENT HOME MAILING ADDRESS (Do not submit a PO Box address) APT. NUMBER
CITY
STATE
ZIP CODE
COUNTRY (if other than U.S.) PERMANENT HOME PHONE
8.
-
-
-
RACE / ETHNICITY (You may check only one, even if you identify with more than one of these groups.)
Page 1 of 8
African American
American Indian/Alaska Native
Hispanic American
Asian Pacific Islander American
Other
-
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
A. Applicant's Personal Information (continued)
9.
Legal Status Yes
U.S. Citizen
10.
Are you a member of the NAACP? Yes
11.
No
No
If Yes, to what Branch, Youth Council, or College Chapter do you belong?
Indicate the NAACP Scholarship for which you are applying (mark only one per application).
The NAACP Agnes Jones Jackson Scholarship
The NAACP Lillian & Samuel Sutton Education Scholarship
The NAACP Earl G. Graves Scholarship
The NAACP Roy Wilkins Scholarship
The NAACP HBCU Scholarship
The NAACP Hubertus W.V. Willems Scholarship
B. Educational Status
12.
College / University Attending or have been accepted
SCHOOL ATTENDING ADDRESS
CITY
STATE
-
ZIP
MAJOR ANTICIPATED GRADUATION DATE (MM/YYYY)
CLASSIFICATION CUMULATIVE GPA (4.00 SCALE)
Page 2 of 8
.
CLASS RANK
/
PERCENTILE
/ %
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
C. Honors and Awards; Leadership
13.
HONORS AND AWARDS
TYPE OF HONOR/AWARD NAME OF AWARD
(List and indicate the type of honors and awards you have received.)
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE DATE RECEIVED (MM/YYYY)
TYPE OF HONOR/AWARD NAME OF AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE DATE RECEIVED (MM/YYYY)
TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
EMPLOYMENT
/ EMPLOYMENT
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY)
Page 3 of 8
/
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
C. Honors and Awards; Leadership (continued)
14.
NAACP Leadership Roles
(Please describe the leadership roles you have held within the NAACP.) MM/YYYY
NAME OF ORGANIZATION POSITION HELD/ROLE Student Classification When Activity Performed
High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE
Page 4 of 8
High School
Undergraduate
FROM
/
TO
/
FROM
/
TO
/
FROM
/
TO
/
FROM
/
TO
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
TO
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
FROM
Graduate
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
C. Honors and Awards; Leadership (continued)
15.
Other Leadership Roles
(Please describe the civil / social activities you have participated in outside of the NAACP.) MM/YYYY
NAME OF ORGANIZATION POSITION HELD/ROLE Student Classification When Activity Performed
High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE
Page 5 of 8
High School
Undergraduate
FROM
/
TO
/
FROM
/
TO
/
FROM
/
TO
/
FROM
/
TO
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
TO
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
FROM
Graduate
Applicant's Social Security Number
-
-
FIRST NAME
3909
D. Recommender's Information: Academic Reference (Required for all applications) LAST NAME
RECOMMENDER'S TITLE / OCCUPATION
MAILING ADDRESS
APT. NUMBER
STATE >
CITY> Recommender's Business Phone Number
-
-
Recommender's Fax Number
-
-
ZIP CODE >
Recommender's Cell Phone Number
-
-
-
Recommender's E-mail Address
E. Recommender's Information: 2nd Academic Reference (Required for Earl Graves and Agnes Jones Jackson Scholarship Applications) FIRST NAME
LAST NAME
RECOMMENDER'S TITLE / OCCUPATION
MAILING ADDRESS
APT. NUMBER
CITY>
STATE >
Recommender's Business Phone Number
Recommender's E-mail Address
Page 6 of 8
-
Recommender's Fax Number
-
-
ZIP CODE >
Recommender's Cell Phone Number
-
-
-
Applicant's Social Security Number
-
-
FIRST NAME
3909
F. Recommender's Information: Personal Reference (Required for all applications) LAST NAME
RECOMMENDER'S TITLE / OCCUPATION
MAILING ADDRESS
APT. NUMBER
STATE >
CITY> Recommender's Business Phone Number
-
-
Recommender's Fax Number
-
-
ZIP CODE >
Recommender's Cell Phone Number
-
-
-
Recommender's E-mail Address
G. Recommender's Information: NAACP Reference (Required for Hubertus Willems, Louis Stokes, and Agnes Jones Jackson Scholarship Applications) FIRST NAME
LAST NAME
RECOMMENDER'S TITLE / OCCUPATION
MAILING ADDRESS
APT. NUMBER
CITY>
STATE >
Recommender's Business Phone Number
Recommender's E-mail Address
Page 7 of 8
-
Recommender's Fax Number
-
-
ZIP CODE >
Recommender's Cell Phone Number
-
-
-
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
H. Essay (Your name and Social Security Number MUST be present at the top of your Essay.) Please attach a typed or legibly printed one page essay explaining what led to your interest in your particular major and what career you ultimately wish to pursue. Include a description of your life's ambition, what you hope to accomplish or achieve in your lifetime, and what position you hope to attain. What do you consider to be your most significant contribution to your community? Explain in what three ways you consider your contribution to be significant.
I. Income Verification (For completion by Agnes Jones Jackson, HBCU, and Hubertus Willems applicants only.) Per the financial need limits, please indicate which household income level you meet. Persons in Family
Income Limit
Persons in Family
Income Limit
1
$ 14,355.00
5
$ 33,91500
2
$ 19,245.00
6
$ 38,805.00
3
$ 24,135.00
7
$ 43,695.00
4
$ 29,025.00
8
$ 48,585.00
J. Signature Your signature is required below. Without it, your application is not complete and cannot be processed. I hereby certify that the information provided in this application is, to the best of my knowledge, true and correct. I have not knowingly withheld any facts or circumstances that would jeopardize consideration of this application, and can provide documentation to prove I am legally authorized to work in the United States. In addition, NAACP and UNCF may use all information obtained from this application for marketing purposes. Dependents of employees or officers of NAACP and UNCF are not eligible to participate in this program.
APPLICANT'S SIGNATURE
DATE
We will use the information you supply on this form solely to evaluate you as a candidate for a scholarship. This information will not be available to third parties for any other purpose.
Page 8 of 8
APPLICATION INSTRUCTIONS Application forms and required documents must be postmarked on or before the last Friday in the month of March. GENERAL INSTRUCTIONS: Please read the following information before completing this application. 1. You must fully complete a separate typed application for each scholarship for which you are applying. If you need more than one application, you must photocopy the enclosed application. 2. Complete and attach the title page and all supporting documents to each complete application. FOR EXAMPLE: IF YOU ARE APPLYING FOR THE HBCU SCHOLARSHIP FUND AND THE ROY WILKINS SCHOLARSHIP, TWO APPLICATIONS MUST BE SUBMITTED
WITH THE HBCU SCHOLARSHIP FUND YOU SHOULD ATTACH: A. Title page for the HBCU Scholarship Fund B. Three recommendation letters C. An official transcript D. Financial verification information E. Evidence of full-time enrollment F. One page essay THEN, A SEPARATE TYPED APPLICATION MUST BE SUBMITTED FOR THE ROY WILKINS SCHOLARSHIP; WITH IT YOU SHOULD ATTACH: A. Title page for the Roy Wilkins Scholarship B. Two recommendation letters C. An official transcript D. Financial verification information E. College/University Acceptance Letter F. Verification of NAACP membership G. One page essay All applications must include the required materials. The UNCF/NAACP will not be responsible for making duplicate copies of applications and/or required materials. If required materials are not included with each separate application, your application will be considered incomplete. All incomplete applications will be disqualified. Send to: The United Negro College Fund Scholarships & Grants Administration 8260 Willow Oaks Corporate Drive Fairfax, VA 22031 ATTN: Kimberly Hall Phone: 703.205.3400 www.uncf.org
Scholarship recipients will be listed on the NAACP web page (www.naacp.org) by MidJuly of each year. Only scholarship recipients will receive official notification.
-1–
TITLE PAGE
THE EARL G. GRAVES SCHOLARSHIP Please sign and attach this page to completed typed application
ELIGIBILTY CRITERIA •
Applicant must be a junior or senior Business major enrolled in an accredited college or university in the United States; or a graduate student enrolled or accepted to a master’s or doctoral program within a Business school at an accredited college or university in the United States (Applicant may apply during their sophomore year).
•
Applicant must currently be in good academic standing and making satisfactory progress toward an undergraduate or graduate degree.
•
Applicant must be a full-time student.
•
Applicant must be in the top 20% of his/her class
•
Applicant need not demonstrate a financial need. Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: $5,000 REQUIRED MATERIAL Please submit the following with your completed TYPED application: •
Three letters of recommendation (other than relatives): One personal reference, two academic references from the business school of the accredited college (academic letters must be on official letterhead).
•
Recent official college transcript.
•
Evidence of full-time enrollment. If selected, verification of enrollment must be furnished.
•
One page essay (see section H of the “Applicant Personal Information Form”) Have you included?
One Page Essay ___
Three Recommendations ___
Transcript ___
Verification of Enrollment ___
Student Signature: ______________________________________________ Date: __________________
-2–
TITLE PAGE
THE AGNES JONES JACKSON SCHOLARSHIP Please sign and attach this page to completed typed application
ELIGIBILTY CRITERIA •
Applicant must be a current member of the NAACP. Applicant must submit a copy of their NAACP membership card or membership application to verify membership.
•
Applicant must be a citizen of the United States and be enrolled in an accredited college or university in the United States.
•
Undergraduate applicant must be a full-time student. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester. Graduate applicant may be a full- or part-time student.
•
Graduating high school seniors and undergraduate students must possess a grade point average of 2.5 (C+) on a 4.0 system. Graduate students must possess a 3.0 (B) average on a 4.0 system.
•
Applicant must demonstrate financial need based on the following scale:
Persons in Family 1 2 3 4
Income Limits $ 14,355 $ 19,245 $ 24,135 $ 29,025
Persons in Family 5 6 7 8
Income Limits $ 33,915 $ 38,805 $ 43,695 $ 48,585
•
Applicants who exceed the income limitations may apply and compete for a certain amount set aside for those students.
•
Renewals will not be automatic. Recipients will have to compete for the renewal of their scholarships. Additional information, such as the most recent cumulative grade point average, NAACP activities, as well as other civil rights activities, and academic awards will be considered. The renewal award may be reduced or denied based on insufficient NAACP activities.
•
Applicants for the Agnes Jones Scholarship must not have reached the age of 25 by the application deadline. Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: Undergraduate: $1,500
Graduate: $2,500
REQUIRED MATERIALS Please submit the following with you completed TYPED application: •
Three letters of recommendation (other than relatives): One personal reference, one academic reference and one NAACP reference. -3–
TITLE PAGE
The NAACP letter of recommendation should be from the Advisor of the Youth Council or College Chapter; member of the Executive Committee of the Branch, Youth or College Chapter; member of the National Board; SCF Trustees; member of the National Youth Work Committee; or NAACP employee, except for those persons who are current members of the Scholarship Committee. Persons submitting letters must specify title and use NAACP letterhead. •
Recent official transcript of grades (high school or college).
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
Evidence of full-time enrollment or application for full-time enrollment for undergraduate applicants (verified by a copy of the application for enrollment; acceptance letter, or letter from the university verifying status). If selected, verification of enrollment must be furnished.
•
Evidence of NAACP membership, verified by a copy of membership card or receipt of membership.
•
One page essay (see section H of the “Applicant Personal Information Form”)
Have you included? Transcript ___ Three Recommendations ___
Verification of NAACP Membership ___ Verification of Enrollment ___
Student Signature: ____________________________________________
Financial Information ____ One Page Essay ____
Date: ___________________
-4-
TITLE PAGE
THE HBCU SCHOLARSHIP FUND Please sign and attach this page to completed typed application
ELIGIBILITY CRITERIA •
Applicant must be a current student or incoming freshman at a Historically Black College or University.
•
Applicant must be a citizen of the United States and apply to be accepted at an accredited college (excluding proprietary schools) in the United States.
•
Applicant must be a full-time student. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester.
•
Applicants must possess a cumulative grade point average of 2.5 (C+) on a 4.0 system.
•
NAACP membership and participation is highly desirable.
•
Applicant must demonstrate financial need based on the following scale:
Persons in Family 1 2 3 4
Income Limits $ 14,355 $ 19,245 $ 24,135 $ 29,025
Persons in Family 5 6 7 8
Income Limits $ 33,915 $ 38,805 $ 43,695 $ 48,585
Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: $2,000
-5-
TITLE PAGE
REQUIRED MATERIALS Please submit the following with your completed TYPED application: •
Three letters of recommendation (other than relatives): One personal, one academic reference and one NAACP reference. The NAACP letter of recommendation should be from the Advisor of the Youth Council or College Chapter; member of the Executive Committee of the Branch, Youth or College Chapter; member or the National Board; SCF Trustees; member of the National Youth Work Committee; or NAACP employee, except for those persons who are current members of the Scholarship Committee. Persons submitting letters must specify title and use NAACP letterhead.
•
Recent official transcript of grades.
•
One page essay (see section H of the “Applicant Personal Information Form”)
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms
NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
Evidence of full-time enrollment or application for full-time enrollment. If selected, verification of enrollment must be furnished.
Have you included? Transcript____ Three Recommendations____
Verification of NAACP Membership ____
Financial Information ___
Verification of Enrollment ____
One Page Essay ___
Student Signature: ____________________________________________ Date: ____________________
-6–
TITLE PAGE
THE LILLIAN & SAMUEL SUTTON EDUCATION SCHOLARSHIP Please sign and attach this page to completed typed application
ELIGIBILTY CRITERIA •
Applicant must be an Education major and a United States citizen enrolled in an accredited college in the United States.
•
NAACP membership and participation is highly desirable.
•
Undergraduate applicant must be a full-time student. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester. Graduate students may be full or part-time students.
•
Graduating high school seniors and undergraduate students must possess a grade point average of 2.5 (C+) on a 4.0 system. Graduate students must possess a 3.0 (B) average on a 4.0 system.
•
Renewals will not be automatic. Recipients will have to compete for the renewal of their scholarship and must maintain a 2.5 GPA for undergraduates and a 3.0 for graduates to qualify for renewal. Additional information such as recent GPA, and verification of education major will be considered. Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: Undergraduate: $1,000
Graduate: $2,000
REQUIRED MATERIALS Please submit the following with your completed TYPED application: •
Two letters of recommendation from a teacher or professor in the major field of specialization. Letters must be typed on appropriate letterhead.
•
Evidence of full-time enrollment or application for full-time enrollment for undergraduate applicants (verified by a copy of the enrollment application; acceptance letter; or letter from the university verifying status). If selected, verification of enrollment must be submitted.
•
Recent official college transcript.
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
One page essay (see section H of the “Applicant Personal Information Form”)
-7–
TITLE PAGE
Have you included? Transcript____
Verification of Employment ____
Two Recommendations ___
Financial Information____
Verification of NAACP Membership ____
One Page Essay ___
For High School Seniors Only: College/University Acceptance Letter ____
Student Signature: ____________________________________ Date: ____________________________
-8 –
TITLE PAGE
THE ROY WILKINS SCHOLARSHIP Please sign and attach this page to completed typed application
ELIGIBILTY CRITERIA •
Applicant must be an entering college freshman.
•
Applicant must be a citizen of the United States and seeking enrollment in an accredited college in the United States.
•
NAACP membership and participation is highly desirable.
•
Undergraduate applicants must be full-time students. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester.
•
Applicant must possess a grade point average of at least 2.5 (C+) on a 4.0 system.
•
The Roy Wilkins Scholarship is not renewable. Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: $1,000 REQUIRED MATERIALS Please submit the following with your completed TYPED application: •
Two letters of recommendation (other than relatives): One personal reference and one academic reference.
•
Current official transcript of grades (high school).
•
Copy of application for admission or letter of acceptance from college or university.
•
Copy of NAACP membership card or receipt of membership.
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
One page essay (see section H of the “Applicant Personal Information Form”)
-9-
TITLE PAGE
Have you included? Transcript ____ Two Recommendations ____
Verification of NAACP Membership ____
College/University Acceptance Letter ___
Financial Information ____
One Page Essay ___
Student Signature: ____________________________________________ Date: ____________________
- 10 –
TITLE PAGE
THE HUBERTUS W.V. WILLEMS SCHOLARSHIP FOR MALE STUDENTS Please sign and attach this page to completed typed application
ELIGIBILITY CRITERIA •
Applicant must be a male majoring in one of the following fields: Engineering, Chemistry, Physics or Mathematical Sciences.
•
Applicant must be a citizen of the United States and be applying to or accepted at an accredited college (excluding proprietary schools) in the United States.
•
NAACP membership and participation is highly desirable.
•
Undergraduate applicant must be a full-time student. If a student drops below the required full-time status, the Scholarship Selection Committee will adjust the grant received to 50% of the award allocated for that semester. Graduate applicant may be a full or part-time student.
•
Graduating high school seniors and undergraduate students must possess a grade point average of 2.5 (C+) on a 4.0 system.
•
Graduate student must possess a 3.0 (B) average on a 4.0 system
•
Applicant must demonstrate financial need based on the following scale:
Persons in Family 1 2 3 4
Income Limits $ 14,355 $ 19,245 $ 24,135 $ 29,025
Persons in Family 5 6 7 8
Income Limits $ 33,915 $ 38,805 $ 43,695 $ 48,585
Members of the National NAACP Board of Directors, SCF Trustees, National Youth Work Committee, the NAACP Scholarship Selection Committee, employees and their spouses or families to the first degree of consanguinity are not eligible to apply for or receive this scholarship.
AWARD: Undergraduate: $2,000
Graduate: $3,000
REQUIRED MATERIALS Please submit the following with your completed TYPED application: •
Two letters of recommendation from a teachers or professors in the major field of specialization. Letters must be typed on appropriate letterhead.
•
Recent official transcript of grades.
- 11 –
TITLE PAGE
•
Financial Verification Information -College Scholarship Service, Princeton, New Jersey 08540 or -Student Aid Report (SAR) or -Free Application for Federal Student Aid (FAFSA) or -Complete copy of parents’ most recent Income Tax Forms NOTE: Student Aid Report (SAR) – After the Department of Education processes your FAFSA application, you will be sent a Student Aid Report (SAR). The SAR outlines the information you provided on the FAFSA and reports your Expected Family Contribution (EFC).
•
Evidence of full-time enrollment or application for full-time enrollment. If selected, verification of enrollment must be furnished.
•
One page essay (see section H of the “Applicant Personal Information Form”)
Have you included? Transcript ____
Two Recommendations ____
Financial Information ____
Verification of Enrollment ____
Verification of NAACP Membership ____
One Page Essay ___
Student Signature: _________________________________________
Date: ______________________
- 12 -
Applicant's Social Security Number
3909
-
NAACP Scholarship APPLICANT PERSONAL INFORMATION FORM 2006-2007
To submit this application, please print in black or dark blue ink. For each multiple choice question, fill in the appropriate circle; for the essay question, you must type your response.
A. Applicant's Personal Information
1.
APPLICANT'S FULL LEGAL NAME MIDDLE
FIRST
LAST
2.
3.
GENDER MALE FEMALE
6. 7.
4.
DATE OF BIRTH
-
-
5.
SOCIAL SECURITY NUMBER
-
CURRENT SCHOOL PHONE NUMBER
-
-
E-MAIL ADDRESS
NO. & STREET ADDRESS
PERMANENT HOME MAILING ADDRESS (Do not submit a PO Box address) APT. NUMBER
CITY
STATE
ZIP CODE
COUNTRY (if other than U.S.) PERMANENT HOME PHONE
8.
-
-
-
RACE / ETHNICITY (You may check only one, even if you identify with more than one of these groups.)
Page 1 of 8
African American
American Indian/Alaska Native
Hispanic American
Asian Pacific Islander American
Other
-
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
A. Applicant's Personal Information (continued)
9.
Legal Status Yes
U.S. Citizen
10.
Are you a member of the NAACP? Yes
11.
No
No
If Yes, to what Branch, Youth Council, or College Chapter do you belong?
Indicate the NAACP Scholarship for which you are applying (mark only one per application).
The NAACP Agnes Jones Jackson Scholarship
The NAACP Lillian & Samuel Sutton Education Scholarship
The NAACP Earl G. Graves Scholarship
The NAACP Roy Wilkins Scholarship
The NAACP HBCU Scholarship
The NAACP Hubertus W.V. Willems Scholarship
B. Educational Status
12.
College / University Attending or have been accepted
SCHOOL ATTENDING ADDRESS
CITY
STATE
-
ZIP
MAJOR ANTICIPATED GRADUATION DATE (MM/YYYY)
CLASSIFICATION CUMULATIVE GPA (4.00 SCALE)
Page 2 of 8
.
CLASS RANK
/
PERCENTILE
/ %
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
C. Honors and Awards; Leadership
13.
HONORS AND AWARDS
TYPE OF HONOR/AWARD NAME OF AWARD
(List and indicate the type of honors and awards you have received.)
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE DATE RECEIVED (MM/YYYY)
TYPE OF HONOR/AWARD NAME OF AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE DATE RECEIVED (MM/YYYY)
TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
EMPLOYMENT
/ EMPLOYMENT
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY) TYPE OF HONOR/AWARD
ACADEMIC
ATHLETIC
ARTISTIC
COMMUNITY SERVICE
/ EMPLOYMENT
NAME OF AWARD DATE RECEIVED (MM/YYYY)
Page 3 of 8
/
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
EXTRACURRICULAR Student Classification When Awarded
High School Undergraduate Graduate
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
C. Honors and Awards; Leadership (continued)
14.
NAACP Leadership Roles
(Please describe the leadership roles you have held within the NAACP.) MM/YYYY
NAME OF ORGANIZATION POSITION HELD/ROLE Student Classification When Activity Performed
High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE
Page 4 of 8
High School
Undergraduate
FROM
/
TO
/
FROM
/
TO
/
FROM
/
TO
/
FROM
/
TO
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
TO
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
FROM
Graduate
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
C. Honors and Awards; Leadership (continued)
15.
Other Leadership Roles
(Please describe the civil / social activities you have participated in outside of the NAACP.) MM/YYYY
NAME OF ORGANIZATION POSITION HELD/ROLE Student Classification When Activity Performed
High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE High School
Undergraduate
POSITION HELD/ROLE
Page 5 of 8
High School
Undergraduate
FROM
/
TO
/
FROM
/
TO
/
FROM
/
TO
/
FROM
/
TO
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
TO
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
/
Graduate
NAME OF ORGANIZATION
Student Classification When Activity Performed
FROM
Graduate
Applicant's Social Security Number
-
-
FIRST NAME
3909
D. Recommender's Information: Academic Reference (Required for all applications) LAST NAME
RECOMMENDER'S TITLE / OCCUPATION
MAILING ADDRESS
APT. NUMBER
STATE >
CITY> Recommender's Business Phone Number
-
-
Recommender's Fax Number
-
-
ZIP CODE >
Recommender's Cell Phone Number
-
-
-
Recommender's E-mail Address
E. Recommender's Information: 2nd Academic Reference (Required for Earl Graves and Agnes Jones Jackson Scholarship Applications) FIRST NAME
LAST NAME
RECOMMENDER'S TITLE / OCCUPATION
MAILING ADDRESS
APT. NUMBER
CITY>
STATE >
Recommender's Business Phone Number
Recommender's E-mail Address
Page 6 of 8
-
Recommender's Fax Number
-
-
ZIP CODE >
Recommender's Cell Phone Number
-
-
-
Applicant's Social Security Number
-
-
FIRST NAME
3909
F. Recommender's Information: Personal Reference (Required for all applications) LAST NAME
RECOMMENDER'S TITLE / OCCUPATION
MAILING ADDRESS
APT. NUMBER
STATE >
CITY> Recommender's Business Phone Number
-
-
Recommender's Fax Number
-
-
ZIP CODE >
Recommender's Cell Phone Number
-
-
-
Recommender's E-mail Address
G. Recommender's Information: NAACP Reference (Required for Hubertus Willems, Louis Stokes, and Agnes Jones Jackson Scholarship Applications) FIRST NAME
LAST NAME
RECOMMENDER'S TITLE / OCCUPATION
MAILING ADDRESS
APT. NUMBER
CITY>
STATE >
Recommender's Business Phone Number
Recommender's E-mail Address
Page 7 of 8
-
Recommender's Fax Number
-
-
ZIP CODE >
Recommender's Cell Phone Number
-
-
-
Applicant's Social Security Number
APPLICANT PERSONAL INFORMATION FORM
3909
-
H. Essay (Your name and Social Security Number MUST be present at the top of your Essay.) Please attach a typed or legibly printed one page essay explaining what led to your interest in your particular major and what career you ultimately wish to pursue. Include a description of your life's ambition, what you hope to accomplish or achieve in your lifetime, and what position you hope to attain. What do you consider to be your most significant contribution to your community? Explain in what three ways you consider your contribution to be significant.
I. Income Verification (For completion by Agnes Jones Jackson, HBCU, and Hubertus Willems applicants only.) Per the financial need limits, please indicate which household income level you meet. Persons in Family
Income Limit
Persons in Family
Income Limit
1
$ 14,355.00
5
$ 33,91500
2
$ 19,245.00
6
$ 38,805.00
3
$ 24,135.00
7
$ 43,695.00
4
$ 29,025.00
8
$ 48,585.00
J. Signature Your signature is required below. Without it, your application is not complete and cannot be processed. I hereby certify that the information provided in this application is, to the best of my knowledge, true and correct. I have not knowingly withheld any facts or circumstances that would jeopardize consideration of this application, and can provide documentation to prove I am legally authorized to work in the United States. In addition, NAACP and UNCF may use all information obtained from this application for marketing purposes. Dependents of employees or officers of NAACP and UNCF are not eligible to participate in this program.
APPLICANT'S SIGNATURE
DATE
We will use the information you supply on this form solely to evaluate you as a candidate for a scholarship. This information will not be available to third parties for any other purpose.
Page 8 of 8
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