Mcneese State University Alumni Association

McNeese State University Alumni Association

Black Alumni Chapter

2015 Scholarship Application Cover Sheet

Eligibility:

The applicant must be a graduating black high school senior.
The applicant must attend McNeese State University in the Fall 2015 semester upon graduating from high school.
The applicant must have applied for and been accepted for admission at McNeese State University.
The applicant must have at least a minimum 2.5 high school GPA and have one of the following: an ACT score of 20, or ranked in the top 35% of the graduating class, or a 2.75 cumulative high school GPA on a 4.0 scale which must be verified by their High School Counselor.

Requirements:

Scholarship applications must be received in the MSUAA-Black Alumni Chapter, MSU Box 90775, Lake Charles, LA 70609 by March 1, 2015.
All information must be completed by the applicant, school representative, and/or parent/legal guardian per instructions.
Required documents must accompany the application.
Applicant’s two references must be nonrelatives.
The applicant’s official high school transcript with school seal and ACT high school report must be included with the scholarship application.
Incomplete information will void the application.
Essay must be typed doubled-space and must be two pages minimum and three pages maximum.

Please, forward the completed application and required documents to:

McNeese State University Alumni Association

Black Alumni Chapter

MSU Box 90775

Lake Charles, LA 70609

For questions:

Phone: 337-475-5232

1-800-475-258

E-mail:

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McNeese State University Alumni Association

Black Alumni Chapter

2014 Scholarship Application

Please, attach a passport quality photo below.

PERSONAL DATA

1. Last Name:______First Name:______Middle Initial: ____

2a. Street Address: ______

2b. City: ______Parish:______State:____Zip:______

3a. Daytime Phone: ______3b. Evening Phone: ______

3c. Cellular Phone: ______3d. E-Mail:______

4a. Date of Birth: ______4b. Place of Birth:______

5a. Sex: ____Male ____Female 5b. Marital Status: _____Single ____ Married _____ Other

6. Dependents: _____ Yes _____No If yes, number of dependents ______

7. Citizenship Status: _____ U.S. Citizen _____ Permanent Resident _____ Student Visa

8. Name and address of the school you will be attending in the fall:

______

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9. Current year in school: High School: _____ Yes _____No

Expected date of graduation: ______

Date of Senior Awards Program: ______

10. Anticipated Majors: ______Degree Sought:______

11. Your plans upon graduation from McNeese: ______

______

12. Extracurricular Activities: List all extracurricular activities including skills, especially leadership positions held and hobbies. Describe briefly any activity not well-known. (Use additional paper if necessary)

______

13. Distinctions, honors, awards: Indicate the basis of selection for any award that is not well known. (Use additional paper if necessary)

______

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14. References: List two adults who best know your academic qualifications, including academic performance, potential and motivation. One of the references must be a faculty member who has known you for at least two years.

Position

Name Address & Institution Phone#

1. ______

2. ______

TO BE COMPLETED BY A SCHOOL REPRESENTATIVE

Name: ______Title: ______Phone: ______

Applicant’s Name: ______School: ______

1. Applicant’s Cumulative GPA ____ High School Class size:____ High School Class rank:____

If a rank is not available, please approximate the student’s position to the nearest tenth percentand/or provide a grade

distribution for the class.

2. Is this student eligible for TOPS program? _____Yes _____No

3. To your knowledge is the applicant a recipient of a scholarship?

_____Yes _____No _____Unknown

4. If the applicant is a scholarship recipient, what scholarship(s)? ______

______

Signature of School Official Date

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FINANCIAL DATA (2011)

Both income and expenses must be completed before the application can be considered.

Estimated expenses for school year Estimated income

Tuition and Fees $ ______College Savings $ ______

Books and supplies ______Expected earnings ______

Housing ______Support from parents ______

Food ______Grants (PELL, etc.) ______

Personal items ______Loans ______

Transportation ______Work study ______

Scholarship ______

Spouse’s income ______

Other income ______

TOPS ______

Public Assistance ______

Total Expenses $ ______Total Income $ ______

TO BE COMPLETED BY PARENT(S) OR GUARDIAN(S)

Father’s name: ______Employer: ______Occupation: ______

Father’s Gross Income: $______

Mother’s name: ______Employer: ______Occupation: ______

Mother’s Gross Income: $______

Spouse’s name: ______Employer: ______Occupation: ______Spouse’s Gross Income: $______

(If married)

Name(s) and age(s) of persons dependent on parents/spouse’s income:

1. ______2. ______

3. ______4. ______

If you are self-supporting student, list name(s) and age(s) of dependents, if any:

1. ______2. ______

3. ______4. ______

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VERIFICATION

Please, sign below as required.

1. I understand that the attached photograph may be used to promote the McNeese State

University Alumni Association- Black Alumni Chapter Scholarship.

2. Are you a dependent (daughter, son, step-daughter, step-sonor other dependent) of a member

of McNeese State University Alumni Association-Black Alumni Chapter?

_____Yes_____No If yes what is the name of the Alumni member? ______

3. We (applicant and parent/guardian) certify that the information we (applicant and

parent/guardian) have provided is true and complete to the best of our

knowledge.

By signing this application you understand that if you purposely provide false or misleading

information this award may be revoked. Repayment of any amounts received may be required.

Should the applicant receive this scholarship, the McNeese State University Alumni Association

Black Alumni Chapter is authorized to release award information to news media and other persons deemed appropriate.

______

Applicant Signature Parent/Guardian Signature Date

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ESSAY

Describe your most meaningful achievements and how they relate to the field of study you have chosen and your future goals. Include in your essay a discussion of some of the major challenges you have faced and how you have been able to overcome them.

Please, Type

Two Pages (Minimum) - Three Pages (Maximum)

Doubled Spaced

12 PT. Times New Roman Font

1” Margins

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