Ecolia A. Dunn
Scholarship Application Cover Page
Upon completion of application, return it to your Guidance Counselor or mailedto the above address by April 15, 2011. Applications received after this date will not be considered. Ensure that this cover sheet is included with your application when you submit it.
Date application received: ______
APPLICATION
FOR
ALPHA PHI ALPHA FRATERNITY
SCHOLARSHIP AWARD
ACADEMIC YEAR 2010-2011
1. NAME: ______
(FIRST)(MIDDLE)(LAST)
2. ADDRESS: ______
______
3. PHONE: ______
4. DATE OF BIRTH: ___/___/____
M D YR
5. RACE/NATIONAL ORIGIN: ______
6. SCHOOL PRESENTLY ATTENDING: ______
7. SCHOOL ADDRESS: ______
8. GUIDANCE COUNSELOR: ______PHONE: ______
9. A. CURRENT GRADE POINT AVERAGE: ______
B. CIRCLE THE APPROXIMATE LETTER VALUE FOR THE AVERAGE CITED
ABOVE: A+ A A- B+ B B- C+ C C-
C. COLLEGE BOARD SCORES (SAT): VERBAL ____ MATH ____ COMP ___
(ACT):
D. RANK IN CLASS: ____ OUT OF ____
ALL APPLICANTS ARE REQUIRED TO SUBMIT A RECENT OFFICIAL COPY
OF THEIR TRANSCRIPTS TO VERIFY THE ABOVE INFORMATION.
10. LIST ANY ACADEMIC HONORS OR ACHIEVEMENTS RECEIVED DURING
HIGH SCHOOL:
______
______
______
______
11. LIST THOSE ORGANIZATIONS WHICH YOU PARTICIPATED IN DURING
HIGH SCHOOL. INCLUDE DATES OF PARTICIPATION AND ANY
POSITION HELD.
______
______
______
______
12. LIST ANY COMMUNITY OR CHURCH AFFILIATED INVOLVEMENT OUTSIDE
OF SCHOOL. INCLUDE ANY POSITIONS THAT YOU HOLD.
______
______
______
13. A. NAME OF PARENTS OR LEGAL GUARDIANS:
FATHER MOTHER
______
B. OCCUPATIONS OF PARENTS/GUARDIANS:
______
C. PARENTS EMPLOYER:
______
14. NUMBER OF BROTHERS AND SISTERS: _____ AGES: ______
15. LIST THE NAMES AND COLLEGES WHICH YOU HAVE BEEN ACCEPTED IN
ORDER OF PREFERENCE:
______
______
______
16. WHAT COURSE OF STUDY WILL YOU PURSUE IN COLLEGE?
______
17. WHAT IS YOUR EVENTUAL CAREER CHOICE?
______
18. WHAT RESOURCES DO YOU HAVE TO PAY FOR YOUR COLLEGE EXPENSES?
A. PERSONAL SAVINGS $ ______
B. EMPLOYMENT $ ______/MONTH
C. PARENTAL CONTRIBUTION $ ______/MONTH
D. OTHER FINANCIAL AID $ ______
(PLEASE SPECIFY)
19. LIST THREE PERSONS IN RESPONSIBLE POSITIONS WHO CAN ATTEST
TO YOUR PERSONAL CHARACTER,ABILITIES,AND QUALIFICATIONS.
AT LEAST ONE OF THESE REFERENCES SHOULD NOT BE ASSOCIATED
WITH YOUR HIGH SCHOOL.
NAME: ______
POSITION: ______PHONE: ______
NAME: ______
POSITION: ______PHONE: ______
NAME: ______
POSITION: ______PHONE: ______
20. ON A SEPARATE SHEET, PLEASE STATE IN 100 TO 200 WORDS, WHY
YOU SHOULD BE CONSIDERED FOR THE ALPHA PHI ALPHA FRATERNITY
SCHOLARSHIP AWARD. PLEASE INCLUDE THIS NARRATIVE WITH YOUR
APPLICATION.
I CERTIFY THAT THE INFORMATION CITED HEREIN, AND WHICH I AUTHORIZE YOU TO VERIFY IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
SIGNATURE OF APPLICANT: ______DATE: ______
SIGNATURE OF PARENT/GUARDIAN: ______DATE: ______
THE INFORMATION SUPPLIED BY THE APPLICANT WILL BE HELD IN THE STRICTEST CONFIDENCE AND WILL BE SHARED ONLY WITH THOSE PERSONS DIRECTLY INVOLVED WITH THE SCHOLARSHIP SELECTION PROCESS.
Please return applications to your school’s guidance counselor’s office or mail no later than April 15, 2011 to:
ALPHA PHI ALPHA FRATERNITY, INC.
KAPPA SIGMA LAMBDA CHAPTER
P.O. BOX 397
KILLEEN, TX76541
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