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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