Institute on Black Life

Scholarship Application Check List

Students may apply for up to two (2) scholarships. To apply, one copy of the following original materials must be submitted before the applicant will be considered for a scholarship:

  • The Institute on Black Life Scholarship application form (below) completed in detail
  • Two (2) current and signed letters of recommendation. Sources can include: teachers, guidance counselors, principals, community members, and community college and university administrators.
  • A one-page essay discussing your academic and professional goals. Include a brief discussion of the major factors that have shaped and influenced your pursuit of these goals. Please discuss important activities, organizations, and events (including travel and employment) in which you have been involved. How are all of these factors paving your path to success?

[Your essay must be double-spaced, 12 point font]

To be considered for an IBL scholarship all APPLICANTS ARE REQUIRED to complete a financial aid (FAFSA) application.The application is available from the USF Office of Financial Aid or on line at

Applicants for the IVORY CLUB SCHOLARSHIP are international students and the FAFSA requirement does not apply.

The Institute on Black Life Scholarship Application
USF ID # / Signature
Legal name in full
(Print/Type)
Last Name / First Name / M.I.

Permanent residence

Number, Street, and Apartment Number
City / State / ZIP

School address

(if different)
Number, Street, and Apartment Number
City / State / ZIP
How is permanent residence established?
(At least two must apply.)
Home address for school registration
Place of registration to vote
Family’s primary residence / Home telephone / ( )
School telephone
(if different) / ( )
E-mail
Other: / Date of birth / Age
Month/Day/Year / Male Female
(Check one) I am a U.S. citizen Permanent Resident Non-US citizen (Country of Origin)
Florida Resident
Ethnic Group:
Current cumulative GPA / Scores: / ACT SAT / Number of college credits earned to date (if applicable)
Graduate Students / GRE/TOEFL / GRE: V______Q______W______
TOEFL: total ______/ Expected date of graduation:
Your Undergraduate and/or Graduate major / Parent(s) earned a college degree / Yes No
Name of scholarship(s)applying for:
Name______
Please list all organizations and activities in which you are involved (include offices held):
List awards, scholarships, publications or special recognitions you have received. List in descending orderof significance.
Two (2) current and signed letters of recommendation are required. Sources can include teachers, guidance counselors, principals, community members, and community college or university administrators. List the names, addresses and telephone numbers of two (2) references below. It is your responsibility to make sure the Institute on Black Life receives the letters.
1. Name
Street Address
City / State / Zip Code / Phone / Email
Position
2. Name
Street Address
City / State / Zip Code / Phone / Email
Position

I herby certify that the information I have submitted as correct. I authorize the release of this information to members of the Institute on Black Life Scholarship Selection Committee and will provide additional information or verification upon request.

If granted the scholarship, I agree to the publication of my name and likeness by the Institute on Black Life and the University of South Florida. I agree to the conditions established for this scholarship award by the Institute on Black Life. I understand that this scholarship award is contingent upon the financial support of the Institute on Black Life and that neither the Institute on Black Life is responsible for any financial liability. I understand that scholarship recipients must attend the Institute on Black Life awards banquet announcing the scholarship award or risk of forfeit of the award.

Parent(s)/Guardian(s) Signature, if applicable: ______

Applicant's Signature: ______

Date Submitted: ______

APPLICATION SUBMISSION DEADLINE

January 15th

Of the USF academic year

University of SouthFlorida

Institute on Black Life

4202 E. Fowler Avenue – FAO 270

Tampa, Florida33620

813-974-9387