Pulaski County Special School District

Pulaski County Special School District

African-American Student Scholarship Application

2016-2017

Application Deadline: On or before April 8, 2016

Last Name: / First Name:
Mailing Address
Street: ______
City: State: ZIP:
Daytime Telephone Number: ( )
Date of Birth: Month Day Year
Current High School: / Number of years attended:
I will be attending the following school in the Fall2016: ______
Proof of acceptance or current student enrollment from the above school is required prior to receipt of funds.
Grade Point Average (GPA): ______(On a 4.0 scale)
Attach proof of GPA. Your most recent school transcript is required.
ACT Score:______orSAT Score: ______
A copy of your ACT or SAT score sheet on high school transcript is required.
Name & address of parent(s) or legal guardian(s):
______
Street: ______City:______State: ______
Zip:______Telephone Number of parent(s) or legal guardian: ______
Parent/Guardian Educational Background: / High School Diploma / Some
College/ Technical School / Associates
Degree / Bachelor’s Degree or higher
Mother
Father
Guardian
Guardian
What specialty/major do you plan to major in as you continue your education?
What are your educational and professional goals and objectives?
List your academic honors, awards and membership activities while in high school:
List your community service activities, hobbies, outside interests, and extracurricular activities:
Personal 500 word Essay (Typed and double-spaced)
Please answer the following question:
How will furthering your education improve the quality of life in your community?
A. The following items must be attached to this application in order for the application to qualify to be reviewed by the Scholarship Committee.
B. Your application will not be considered if these items are not attached. (No exceptions.)
C. Circle “YES” or “NO” to be sure you have attached each item as required.
YES / NO / Three (3) reference letters. Return these completed forms along with the Recommendation Letter(s) in a sealed envelope.
YES / NO / Proof of college acceptance or current student enrollment. A letter of college acceptance or program acceptance is required for receipt of funds.
YES / NO / Most recent high school transcript.
YES / NO / Personal Essay.
Maximum of 500 words.
YES / NO / Waiver of Confidentiality
Verification of Free/Reduced Lunch

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