SCHOLARSHIP APPLICATION FORM IMPORTANT NOTE: Click here to review the Scholarship Criteria and Submission Procedure Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Cell * (###) ### #### Email * Current High School * Date of Graduation: * MM DD YYYY Current GPA: * SAT Score: * ACT Score: * COLLEGE OR UNIVERSITY YOU PLAN TO ATTEND IN THE FALL: * College or University Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Accepted? * Yes No Legal Guardian's Name * Contact Number * (###) ### #### Household Income (Used to determine financial need) * 0 - $14,999 $15,000 - $29,999 $30,000 - $44,999 $45,000 - $59,999 $60,000 and up List any school or community awards or honors you have received (Include organization's name and the year you received the award). * List any school-related organization/activities in which you are or have been involved (Include position held and length of time). * List any volunteer or other community activity involvement outside of school. Include religious activities, charitable organizations, clubs, etc. (Describe position held and length of time). * List any work experiences (Include employer name, position held and length of time). * APPLICATION AND INFORMATION RELEASE STATEMENT The application provided is, to the best of my knowledge, complete and accurate. I understand that false statements in this application will disqualify me from receiving a scholarship award. I understand due to funding, not every eligible applicant will receive an award; however, no application materials will be returned. I give permission for any college or school to release to National Coalition 100 Black Women, Inc. Fort Worth Metropolitan Chapter any information necessary to process my scholarship application. By typing your name below, you attest that you are the applicant listed above. You have read, understood, and agree to the terms and conditions outlined. Applicant Signature * Date * MM DD YYYY I/we hereby represent that we are the parents and/or guardian or next-of-kin of the applicant, a minor, and that I/we voluntarily give my/our consent to the videotaping, photographing, and audio recording of my minor daughter. I understand that materials obtained can be used for marketing purposes and/or released to the media which includes social media. Parent/Legal Guardian Signature: By typing your name below, you attest that you are the legal guardian/parent of applicant listed above. You have read, understood, and agree to the terms and conditions outlined above. * Date * MM DD YYYY Late Applications will not be considered, no exceptions. * I agree NCBW Fort Worth Metropolitan Chapter Scholarship Application Checklist Before submitting your application electronically, please ensure you've included the following materials: * Completed Application: Make sure all sections of the application form are filled out completely. High School Transcript: Submit a current transcript of your grades from your high school. Professional Headshot: Attach a professional headshot where you are dressed appropriately. Two Letters of Recommendation (Submitted Separately): Please note: These letters should not be attached to your application. Instead, your recommenders should submit them directly to scholarship@ncbwfortworth.org. Ensure your recommenders are non-related adults (one from your current school and one from the community) who can speak to your character and responsibility as a student and a citizen. Letter of Interest (1 Page Double Spaced): In this letter, introduce yourself, your academic interests, your school, and any humanitarian acts, community service, or religious activities you participate in. Future Plans & Importance of African American Women (1 Page Double Spaced): In this essay, discuss your future plans and why you believe African American women are influential to our society. Signed and Dated Application with Information Release Statement: Review and sign the application with information release statement before submitting. Once you have confirmed all items are included, proceed with the electronic submission of your application. Thank you for your submission.National Coalition of 100 Black Women, Inc.Fort Worth Metropolitan Chapter
