CHARLES R. DREW MEMORIAL SCHOLARSHIP COMMISSION

Founders: FrankColeman, OscarJ.Cooper, ErnestE. Just, EdgarA.Love (Deceased) OMEGAPSI PHIFRATERNITY, INC. INTERNATIONAL HEADQUARTERS

3951 Snapfinger Parkway, Decatur,GA30035

APPLICATION FOR AWARD OF SCHOLARSHIP OR GRANT

2017

CHECKTHEBOX FOR ALL SCHOLARSHIPSORGRANTSYOU QUALIFYFORAND WISH TOBE CONSIDERED:

(APPLICANTSHOULDREFERTOTHE2013CRDMSCSCHOLARSHIPGUIDELINESFORCRITERIA)

International/District Scholar ofthe Year

Founder’s Memorial Scholarship

Grand Basileus Award

RonaldMcNairScientificAchievement Award HermanDreerScholarship/Leadership Award GeorgeE.Meares Memorial Scholarship

H.Carl MoultrieILegal ScholarAward

W.MontagueCobbMedicalScholarAward

Undergraduateor Graduate Scholarship Grant

Applicants’ Full Name:

FirstMiddleLastSuffix

FORDISTRICTUSEONLYDO NOTWRITE BELOWTHISLINE

Application Packet Received/Postmarked on:

Application Packet Complete(Y or N):

District AwardReceived:

District #:

APPLICATION FOR AWARD OFSCHOLARSHIP OR GRANT

OMEGAPSIPHIFRATERNITY,INC.

TYPEDAPPLICATIONSONLY

AllFields Required UnlessOtherwiseNoted

PART I. PERSONALINFORMATION
Profile
LastName: / First Name: / MiddleName:
Date ofBirth:(MM/DD/YYYY)
PermanentAddress
Street:
City: / State: / ZIP/Postal Code:
SchoolAddress(Optional)
Street:
City: / State: / ZIP/Postal Code:
Phone/E-mail
Primary: ()-CellHomeWork / Phone:()-CellHomeWork
Primary E-MailAddress:(for official communications)E-MailAddress 2:
Employment:
Areyoucurrentlyemployed?YN / Full-timePart-timeN/A
Occupation/Job: / Place of Employment:
Family Information
Marital Status:YN / Number of Children: / Agesof Children:
Father’s Full Name: / Is he living? / Occupation:
Mother’s FullName: / Issheliving? / Occupation:
Number of Brothers: / Ages: / Number of Sisters: / Ages:
Number of brothers/sistersin college:
PART II.MEMBERSHIPINFORMATION(OMEGAPSI PHI FRATERNITY, INC.)
ControlNo.(9-Digit #)
Life Membership No.
Current Chapter: / Current ChapterLocation: / CurrentDistrict:
ChapterInitiatedThrough: / Date Initiated: (MM/YYYY) / DistrictWhereInitiated:
PART III.ACADEMIC INFORMATION:
Post-secondaryClassification
FreshmanSophomoreJuniorSeniorGraduate/ProfessionalOther
SpecifyOther:
High School Info
Name: / Location: / Year Graduated:
Undergraduate Institutions Attended
(Listinchronologicalorder all undergraduate institutions you haveattended orarecurrentlyattendingincluding summers).
InstitutionName / Institution Location / Dates
Attended / Major/Minor / Degree(i.e. B.A.,B.S.) / DateConferredor Expected(Month/Year) / Cum. GPA (4.0 Scale)
Graduate/ProfessionalInstitutions Attended
(Listinchronologicalorder all undergraduate institutions you haveattended orarecurrentlyattendingincluding summers).
InstitutionName / Institution Location / Dates
Attended / Major/Minor / Degree(i.e. M.A..,Ph.D.) / DateConferredor Expected (Month/Year) / Cum. GPA (4.0 Scale)

PART V. BIOGRAPHICALINFORMATION

1. Whatisyourproposedoccupation/professionaswellasshortandlongtermcareergoals?Bespecificas possible.

2. Describeanyextra-curricularactivitiesandcommunity/campusinvolvementincludingjobsorpositionsof responsibilitythatyouhaveheldwithinthem.Ifyouhavehadexperienceincommunityservice,indicate contributionsyouhavemade.

3. Listanddescribeanyleadershippositionsheldwithinthefraternityandwithinthecollege/communityat-large.

Alsolistanyhonorsorawardsreceivedandprovidecorrespondingdatesforall.

4. In200-250words,stateyourpurposeforapplyingatthistime.Indicatehowfundsfromthefraternitycanassist youinachievingyourcareergoals.Intheprocess,pleaseprovidedetailsonyourbackground,motivation,and specificpersonal,familyorothercircumstances,whichmakeit importantforyoutoreceivefinancialassistance.

PART VI.PROFESSIONALREFERENCES
1. AllApplicantsMUSTsubmitthreereferenceletterstotheirDistrictScholarshipChair.
2. ReferencelettersmustbemailedunderseparatecoverbyauthordirectlytoDistrictChairorsentby applicantinaseparatesealedenvelopealongwithapplicationpacket.
3. Applicantwillprovidethename,title,mailingaddressande-mailaddressofthreeindividualswhowill providetheprofessionalreferenceletter.Referencelettersmustcomefromthefollowingsources:
1. Anacademicadministratororfacultyfromyourcurrentinstitution
2. Anactivememberof OmegaPsiPhiFraternity,Inc.
3. Applicant’schoice(At-largereference)
Reference I: Academic administratoror faculty
Name / Title / MailingAddress / E-mail address
Reference II: Active member of Omega Psi PhiFraternity, Inc. (or at-large for non-member applicants)
Name / Title / MailingAddress / E-mail Address
Current Chapter / ControlNumber
Reference III: Applicant’s Choice
Name / Title / MailingAddress / E-mail Address

PART VII. ADDITIONAL REQUIRED INFO

oYoumustsubmitan officialtranscript(s)bearingtheuniversitysealfromtheinstitutionwhichyoucurrentlyattend.

oApplicantsfortheHermanDreerAwardmustalsosubmita 500-wordTYPEDessaydetailingleadershipand humanitarianaccomplishments.Pleaselabeltheessay“HERMANDREERLEADERSHIPESSAY”

oAllscholarshipapplicationswillalsobereviewedby theOmega4Lifeselectioncommitteetodetermineifapplicant meetsinitialqualificationsfortheGEOmega4LifeLeadershipProgram.Potentiallyqualifiedbrotherswillbe contactedtoprovidearesume,digitalphotoandinterviewinconjunctionwiththeCRDMSCscholarshipapplication. Formoreinformation,visit

PART VII. CERTIFICATION

IcertifythatthestatementsIhavemade onthis applicationarecorrect andcomplete tothebestofmyknowledge.Iunderstand that withholding information requested onthisformorknowinglygiving falseinformationwillmakeme ineligible for assistancefromOmegaPsiPhi Fraternity, Inc. FurtherIunderstandthat failure to attend the required scholarshippresentationmayvoidmyscholarshipand award. Lastly, IgranttheOmegaPsi Phi Fraternity, Inc. and the OmegaLife Membership Foundation, Inc. permissiontopublishmyname,picture, and amount of awardandpersonal biographicalinformation inconjunctionwith thisaward.

NAME(Print) Signature: Date:(MM/DD/YYYY)

Checklist for Application Packet:

THIS PAGE IS FOR YOURREFERENCEONLY ANDDOESNOT NEED TOBE SUBMITTED WITH APPLICATION PACKET

Please notethat onlycompleteapplication packets received by published deadlines will be reviewed.

Typed application(Allsections required)

Officialtranscript(s) bearing the university sealina sealed envelope (no electronicsubmissions)

Three professionalreferenceletters (letters received after the deadlinewill notbe considered).

Fraternity membersmust bein good standing andfinancialatthe International, Districtand Chapter levelin order to be qualifiedto receive anaward.

Applicants for the HermanDreer Award must submita typed 500-word essay detailing leadership and humanitarian accomplishments

SUBMISSION REQUIREMENT:

Applicantsmust submitALLinformation to theircurrentdistrict scholarship chairby each district’s respective published date. DONOTMAIL TO IHQ.DONOTsubmitacopyofyourmembershipcard.

YourfinancialstatuswillbeverifieddirectlybyIHQrecords.

DONOTSubmitaphoto.OnlyInternationalscholarshiprecipientswillberequestedtoprovideaphotoafter

awardannouncementinMay.Acolorphotoindigital(.jpg)formatofapplicant'sbust(headandshoulders)inbusinessattire attirewillberequired.

ADDITIONALINFO:

The officialCharles R.Drew Memorial Scholarship Commission’s scholarship guidelines,application, all published district andinternational deadlines andimportant contactinfo areall locatedon the IHQ website at