Scholarship Application
Last Name : First Name: MI:Street Address: City: State: Zip Code:
Phone: Home : Mobile: Other:
Email Address(es):
High School: Junior College (If Applicable):
Address: Phone:
Year Graduated: GPA: ACT Score:
1. Have you been accepted or are you currently attending Alcorn State University? YES or NO
2. What is or will be your classification? ______
3. Do you have any relatives who have graduated or are attending Alcorn State University? YES or NO
If YES, please give name, address and phone number below (please list additional persons on a separate paper and attach):
1. ______
______
______
Phone: ______
2. ______
______
______
Phone: ______
4. What is your planned major and/or minor while attending Alcorn State University? ______
______
5. After graduating from Alcorn State University, will you commit to joining one of the many Alumni Chapters and work to help others achieve a college degree thru your time and/or financial resources? YES or NO
6. What factors played into your selection of Alcorn State University as the college of your choice (200-300 words)? (Type and attach to application)
7. Please list some of your extra curriculum activities and tell how they have or will be used to shape your future career goals. (Type and attach to application)
8. Have you been awarded any other scholarships for the academic year? YES or NO
If YES, please explain: ______
______
9. Please explain in 100-200 words how you plan to use the scholarship funds. (Type and attach to application)
10. Please give the names and phone numbers of at least 3 character references with at least two being from the school of which you have recently graduated.
1. ______
______
______
Phone: ______
2. ______
______
______
Phone: ______
3. ______
______
______
Phone: ______
Please have these individuals submit a letter of reference on your behalf and include it in your application packet.
Completed applications should be mailed to the following: Alcorn Memphis Alumni Chapter
Attn: Scholarship Recipient Committee
Post Office Box 30784
Memphis, TN 38130
Please adhere to the following:
§ Must have an ACT score of 18 or higher
§ Must have a GPA of 2.75 or higher
§ First priority given to Shelby County, TN students, but DeSoto County, MS students may apply
If you are selected as a recipient, a copy of your transcript and ACT scores, as well as proof that you are currently enrolled at Alcorn State University, will be required. Application deadline is October 1, 2014. Notification of awards will be made by October 18, 2014.
If you are selected as a recipient, will you be able to attend our scholarship banquet or send a representative with a response? YES or NO
It will be held on November 1, 2014 at the Holiday Inn Univ. of Memphis, 3700 Central Ave., Memphis, TN 38111 @ 6:00 p.m.
Signature: ______Date: ______