Urban League of Rochester Salute to Black Scholars Program

Submit and update as often as necessary

Generic (Supplemental) Scholarship Application Form

This application is used for scholarships on the Urban League of Rochester Black Scholars Scholarship List that do not have a separate application.

To be considered for these scholarships or awards, you must:

1.  Return this form with your essay(s)

2.  High school transcript to the Black Scholars Office.

3.  Include a copy of your high school transcript for each opportunity/application you want to be considered for.

4.  Include three letter of references.

Senior grades will be required for 2nd marking period or 3rd for schools with six marking periods. Make sure E-mail address and your cell phone numbers are included.

YOU MUST SUBMIT THE ORGANIZATION’S APPLICATION TO BE CONSIDERED FOR THEIR AWARD WHERE APPLICABLE.

Complete the following:

Name: ______SSN :_(last 4 digits)- ______Gender______

First Last

Home Address ______County______Home Phone______

City______State______Zip Code______E-mail______

High School______School Phone______

Address______City______Zip ______

Graduation Year______Grade Point Average ______/______Rank in Class______Class Size______

(Un (weighted/weighted GPA)

Aptitude Test:

ACT Composite Score______or SAT Scores: Verbal ______Math ______Writing______Total ______

(Please submit copy of test scores to us)

Intended major(s) or interest area(s) is/are (please list in order of preference):

First choice______Second choice ______

Long Range Career Goal (i, e. Lawyer, Business Owner, etc)______

College: List the colleges you have applied or intend to apply. (Use a separate sheet if necessary. Application status a – applied b – intend to apply

First ______

Second ______

Third ______

Parent/Guardian

Mother’s Name______Father’s Name ______

Financial Information:

(Total gross family income) We are no longer requesting this information, but be aware most scholarship givers may require a SAR (Student Aid Report) as part of the documentation before making any final selections. Please complete FAFSA form in a timely manner.

Number of dependent brothers/sisters living at home ______Number currently attending college ______as of______

Please list sources of financial aid (including other scholarships, loans, grants received and/or applied for). Attach separate sheet, if needed.

Financial Aid Source Applied for Received

List on separate sheet of paper and update as needed

______

Financial Information Continued

What will you do to bridge any “financial gaps” to fund your education? ______

______

______

Personal Achievements: You may attach a resume in lieu of I, II, III, IV, and V.

I. Extra-curricular Activities or Office Held Year Position Held

______

______

______

II.  Community Service

______

______

III.  Employment

______

______

IV.  Awards

______

______

______

V.  References: List three (3) references and their relationship to you (teacher, employer, clergy, coach, and counselor).

(Submit letters of recommendations/references with application)

______

______

______

Essay: Please write a short essay describing your background, career goals, objectives, and other experiences that have contributed to your personal development and future aspirations. Use a separate sheet. Essay should not exceed 350 words.

SUBMIT COMPLETED FORM TO: Black Scholars Office, Urban League of Rochester, 265 North Clinton Avenue, Rochester, NY 14605; phone (585) 325-6530, ext 3082; or e-mail Ms. Annette Rouse, Coordinator at .

Please return this complete application with a copy of your latest high school transcript.

Applicant signature ______Date ______

Salute to Black Scholars Program (585) 325-6530, x 3082 or 3088

265 North Clinton Avenue Fax: (585) 325-4864 E-mail:

Rochester, New York 14605