Scholarship Application

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SCDC Black Caucus

Scholarship

Form

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Complete the form below to apply for the scholarship OR download a PDF copy here and submit to SCDCBC by the deadline.

A. General Information

First Name

Last Name

Home Address

Street Address

Street Address Line2

City

State

Zip Code

Country

Phone Number

School Address (If known)

Street Address

Street Address Line2

City

State

Zip Code

Country

Phone Number

Citizenship

Country of Citizenship

B. Education Information

School Applicant Attends

Department and Major

Degree Expected

Class you will attend:

Junior

Senior

Schools Previously Attended

College or University

Dates Attended

Degree earned (if any)

Current and Past School Activities and Honors

Date (MM/YY)

Activity/Honor

Current and Past Community Activities and Honors

Date (MM/YY)

Activity/Honor

OPTIONAL: Hometown Newspaper

Newspaper - Name and Address

C. Employment Information

Please list your employment history, including dates, starting with your most recent job. Place an asterisk (*) before any company where your involvement was in the political arena.

Date (MM/YY)

Company Name

City

Company Name

City

Date (MM/YY)

Company Name

City

Date (MM/YY)

Company Name

City

D. Volunteer Information

Please list your volunteer history, including dates, starting with your most recent assignment. Place an asterisk (*) before any company where your involvement was in the political arena.

Date (MM/YY)

Company Name

City

E. Application Documents

Student Statement

Please describe (in 500 or < words) why you are applying for the scholarship, your qualifications, and your career aspirations. Attach your student statement using the upload feature below.

Application Attachments

Please use the upload file feature below to attach all required application documents. This includes the following: transcripts, and your student statement. Otherwise, attachments must be emailed to the email address provided or sent via mail postmarked by the deadline. Letters of recommendation should come directly from the letter writer. ***See application instructions for sending attachments separately from this application.

Transcript

Upload File

Student Statement

Upload File

F. Application Statement

The information provided in my application is, to the best of my knowledge, complete and accurate, and I understand that false statements on this application will disqualify me from the scholarship.

I, (please print name*) ___________________________________ , give permission for any college or school to release to the SCDCBC Scholarship Program any information necessary to process my application to the Program.

Applicant's Signature (use mouse to sign)

Date (MM/DDYYY)

Please Note: All fields with an asterisk (*) are required for application submittal.

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