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Scholarship Application
Scholarship Application
mwitherow
2020-02-11T05:16:42-08:00
Scholarship Application
Name
*
First
Middle
Last
Suffix
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contact Phone
*
Email
*
School
*
School City
*
Grade Level
*
Senior in high school
Undergraduate Student
Graduate Student
Parent/Guardian Contact
Parent/Guardian
*
First
Last
Relationship
*
Parent/Guardian Contact Phone
*
Parent/Guardian Email
Applicant Information
Who is your CLBC representative?
*
Steven Bradford
Autumn Burke
Jim Cooper
Mike Gipson
Christopher Holden
Reginald Byron Jones-Sawyer, Sr.
Sydney Kamlager
Kevin McCarty
- Other -
(Select other if the the names listed do not apply)
Other
Extra Curricular Activities
Activity 1
*
Roles & Responsibilities
*
Activity 2
*
Roles & Responsibilities
*
Activity 3
Roles & Responsibilities
Have you participated in the African-American Leaders of Tomorrow Program (AALT)?
Yes
No
In what year did you participate?
2014
2015
2016
2017
2018
2019
Other
Other year participated
Essay: Personal Statement
*
What is the value of education to you? (750 words or less)
In a short paragraph, please tell us how this scholarship will benefit you.
*
Upload Current Photo
*
Recommendation Letter - community member not related to you
*
Must be dated within the last 90 days.
Recommendation Letter - school representative
*
Must be dated within the last 90 days.
Certified Copy of Transcript
*
College Acceptance Letter OR Proof of High School Diploma from California
*
Comments
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