Continental Societies, Inc.

National Scholarship Application 2015-2016

Chapter North Dade-Broward County Chapter Region Southeastern Region ScholarshipChair Ms. Terry Maxwell Telephone305-333-8135

***Please submit your application through a local ContinentalChapter***

CONTINENTAL SOCIETIES,INC.

NATIONAL SCHOLARSHIPAPPLICATION

APPLICATION MUST BETYPED

INSTITUTION / COURSE / DATES(MM/DD/YY) / GRADE

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COLLEGE INFORMATION (CONTINUED) SUBSTANTIATION OF ACCEPTANCE OR ENROLLMENT MUST BEPROVIDED
PLEASE IDENTIFY THE INSTITUTIONS OFACCEPTANCE
NAME ADDRESS

CITYSTATEZIPCODE / CONTACT
PERSON PHONENUMBER E-MAIL
NAME ADDRESS

CITYSTATEZIPCODE / CONTACT
PERSON PHONENUMBER E-MAIL
ADDITIONALINFORMATION
EMPLOYMENT: FULL - TIME ( ) or PART - TIME( )(PLEASELIST)


INTERNSHIP (BRIEFLYDESCRIBE)



Is internship related to your future college interest? Yes ( ) No ( )
AWARDS/HONORS (PLEASELIST)
COMMUNITY SERVICE (PLEASELIST)

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NATIONAL SCHOLARSHIP APPLICATIONENDORSEMENTS

Applicant’s initials where indicated, and signatures where appropriate, indicate his/her knowledge, understanding and agreement to the Continental Societies, Inc. policies as statedbelow:

Applicant understands and agrees to apply through a local CSI Chapter and Region in order to competeforthe NationalScholarship

Applicant agrees to provide verification of enrollment into a four-year college or university prior toreceiptofthe initial scholarship award, and official transcripts prior to each additionalpayment.

Applicant agrees to provide a photo and grants permission for its use in any of the organization’spublications.

This application contains confidential and/or privileged material and will not be disseminated for any other use by the Continental Societies,Incorporated.

Continental Societies, Incorporated does not discriminate against applicants on the basis of race, religion, national origin or sexual orientation. All qualified applicants areconsidered.

APPLICANT’SSIGNATUREPARENT/GUARDIAN’SSIGNATURE

DATEDATE

NATIONAL SCHOLARSHIP APPLICATION CHECKLIST (Pleaseinitial)

Long rangeplans

Short termgoals

Plans for additional support - should include financial, educational,social/emotional

Justification for receiving CSIScholarship

Personal achievements (honors, awards,recognitions)

ADDITIONAL INFORMATIONREQUIREMENTS

Letter of graduation substantiation from principal orcounselor

Copy of college acceptanceletter

Official Transcript with appropriateseals

SAT or ACT Scores, GPA, classrank

Three Reference Letters (school, church, community,employer)

List of memberships oraffiliations

List of honors andawards

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APPLICATION DEADLINE

The National Committee will not accept applications directly. All applications should be submitted through the approved channels. No applications will be accepted after the MARCH 18thdeadline date.

PLEASE SUBMIT YOUR COMPLETED APPLICATION BY MARCH 18thTO:

Continental Societies, Incorporated

North Dade-Broward County Chapter

ATTN: Scholarship Chairperson

P. O. Box 693921

Miami, Florida 33269

Email:

Chapter Website:

National Website:

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