STATEMENT OF ACCURACY FOR STUDENTS



WWW.National Coalition of 100 Black Women, Inc.Columbia (SC) Chapter2020 COLLEGE SCHOLARSHIP APPLICATION(Please Print or Type)Student Information1.First NameLast NameMiddle Initial2.Mailing AddressCityStateZip3.Student Cell/Alternate Number (Include Area Code)Student Email Address4.Month:Day :Year:Date of Birth5.Cumulative Grade Point Average(GPA)(On a 4.0 scale, unweighted)**Official high school transcript required, (sealed in envelope signed by school counselor). **6.School DistrictName of High School (Currently Attending)School Counselor NameSchool Counselor Phone Number (Include Area Code)School Counselor Email Address7.Anticipated Graduation DateIf you have decided the accredited higher learning institution you will attend Fall of 2020, pleaselist the name of this institution.1.2.3.8.If you haven’t made a selection, list your top 3 choicesWhat are your hobbies and recreational activities? (Include volunteer and community service activities)What leadership roles/positions have you served in?Parent or Legal Guardian Information9.First Parent/Legal Guardian NameMailing AddressCityStateZip*Provide First Parent/Legal Guardian Mailing Address (If different than student)Home/Cell:Work:First Parent/Legal Guardian Phone Number(s) (Include Area Code)Second Parent/Legal Guardian NameMailing AddressCityStateZip*Provide Second Parent/Legal Guardian Mailing Address (If different than student)Home:Work:Other Requirements10.References: Applicants must submit three non-relative references. (including one from school counselor) References should be on official organization, church, business or school letterhead. Examples of possible references include: School teachers, church leaders, community leaders, employers, supervisors, etc.11.A 250 - 500 word typed essay describing how one of the topics below has shaped who you are today and how this has helped your local community. Include challenges or obstacles you have overcome in life and how this will help you succeed in college and beyond.AdvocacyGender EqualityLeadershipSTATEMENT OF ACCURACY FOR STUDENTSI hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge.I hereby understand that if chosen as a scholarship winner, it is mandatory that I attend the chapter’s “Annual My Sister’s Keeper Awards Luncheon “ at the R2i2 Center, 763 Fashion Drive, Columbia, SC at 11:00 AM on Saturday, April 4, 2020 to participate in the scholarship awards ceremony. I hereby understand that the monetary award will be presented to me after proof of enrollment is provided to the scholarship committee.I hereby give National Coalition of 100 Black Women, Inc., Columbia (SC) Chapter permission to use my name, photograph and/or facsimile in the advertisement and promotion of the National Coalition of 100 Black Women, Inc., Columbia (SC) Chapter scholarship program.I hereby understand that if I submit this application without all required attachments and supporting documents, it will be disqualified. Incomplete applications or applications that do not meet eligibility criteria will not be considered for this scholarship.Signature of scholarship applicant:Date: Signature of parent/guardian:Date: The student is responsible for the assembly of a complete application packet and delivery to the school counselor. The school counselor will attach the official transcript and his/her letter of recommendation. INCOMPLETE PACKETS WILL NOT BECONSIDERED.Application Packet ChecklistCompleted Application formThree References (Attach to application)Typed Essay (Attach to application)Official School Transcript (Attach to application)Wallet size photographREMINDER: Application Period: November 1, 2019- January 25, 2020MAIL COMPLETE APPLICATION PACKETNational Coalition of 100 Black Women, Inc. Columbia (SC) ChapterAttn: Scholarship Committee ChairP.O. Box 291117 Columbia, SC 29229COMPLETE APPLICATION PACKET MUST BE POSTMARKED BYJANUARY 25, 2020 (NO EXCEPTIONS) ................
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