SCHOLARSHIP APPLICATION
KAPPA UPSILON CHARITABLE FOUNDATION, INC.
OF
KAPPA UPSILON CHAPTER OF OMEGA PSI PHI FRATERNITY, INC.
SCHOLARSHIP APPLICATION
DEADLINE FEB. 20th, 2019
Please answer all questions on this form. This will help the scholarship committee in selecting those students most eligible for the scholarship award. The information you provide will be kept in the strictest confidence.
Name___________________________________________________________
Last First Middle
Social Security Number________- ________- ______ Age______ Male/Female
Home Address____________________________________________________
Street or P.O. Box
City __________________________State __________Zip Code____________
Telephone (________) ______________ Email___________________________
Father/Guardian________________________Occupation___________________
Mother/Guardian_______________________Occupation___________________
*Parent/Guardian Combined Annual Income From All Sources_______________
*Number Children In Home _____ Ages___________ Number In College_____
Name of High School_______________________ Dates Attended____________
Address_________________________________ Class Rank ________________
SAT Score _______/ ________/_____ ACT Score ______ GPA______/________
Verbal Math Total Numerical Alphabet
Page 2 of 3 Revised 12/15/09
Criteria- Please circle one category
Merit Only
1. Top 10% of high school graduating class.
2. SAT score 1100 or above /ACT score 24 or above.
3. 3.00 GPA senior year of High School.
Merit and Need
4. Top 50% of High school graduating class.
5. SAT score 910 or ACT score 19 or above.
6. 2.50 GPA senior year of High School.
Need Only
7. Top 75% of High school graduating class.
8. SAT score 850 or ACT score 17 or above.
9. 2.00 GPA senior year of High School.
Please list the colleges to which you have applied.
Indicate whether you have been accepted.
__________________________________________________________________ __________________________________________________________________
__________________________________________________________________
__________________________________________________________________
School extracurricular activities (Include positions held, attach copies of awards or certificates, if possible)
________________________________________________________________________
List community Activities and Service (Indicate position held, honors, recognition, etc.)
_______________________________________________________________________
_______________________________________________________________________
To what extent, if any do you need financial assistance? Please be specific.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
How do you plan to finance your college education? Examples: loans, work, contributions from parents, scholarship, etc.
You are applying for an Omega Psi Phi Fraternity Scholarship. What do you know about Omega Psi Phi Fraternity, Inc.?
Page 3 of 3 Revised 12/15/09
GENERAL INFORMATION
A. Please list 3 persons who have known you for at least one year. Have one of the 3 persons submit a character reference to the Scholarship Committee Chairman.
1. Name_______________________________ Phone # ________________
2. Name_______________________________ Phone # ________________
3. Name_______________________________ Phone # ________________
B. Please attach a formal letter of application to the Scholarship Committee Chairman. This letter should include your reason for applying, your interests and hobbies; any honors and achievements acquired in grades 9 - 12 and your short term and long-range career plans.
C. Please have your school mail or submit a copy of your transcript (minimum 2.0 unweighted GPA) to the Scholarship Committee Chairperson.
Transcript was requested ____________________________
D. All of the above information should be received no later than February 20th to the Scholarship Committee.
Scholarship Chairman
c/o Omega Psi Phi Fraternity
P. O. Box 2854
West Palm Beach, Florida 33402-2854
I certify that all information provided herein is true to the best of my knowledge. I realize that my application may be disqualified if false or misleading information is provided.
______________________________ ______________________________
Applicant Parent
________
Date
................
................
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