APP_FORM | GEH Endowment

SCHOLARSHIP APPLICATION

*** Please enter EACH field, do not allow your browser to auto-fill. ***

First Name

MIddle Name

Last Name

Suffix

Email Address

Phone Number

Applicant Address

Present School or Institution

Name of College/University You Plan to Attend

Anticipated Course of Study

Cumulative Unweighted Grade Point Average:

Cum Unweighted GPA

out of

Max Unweighted GPA

Cumulative Weighted Grade Point Average:

Cum Weighted GPA

out of

Max Weighted GPA

Name of Parent(s) or Guardian(s)

Parent/Guardian Address

Family Income (This information is confidential and will not impact the decision-making process in the awarding of scholarships and is only used for grant application demographics from third party sources)

How many family members reside at your address (please include yourself). (This information is confidential and will not impact the decision-making process in the awarding of scholarships, it is only used for grant application demographics from third party sources).

Reason for requesting financial assistance

Top six school based involvements (clubs/sports/class offices) and positions held:

Top six community based involvements (church or civic groups and clubs) and positions held:

Essay

Please write about your future goals and how your degree will help you pursue those goals.

(Please include your typed essay of no less than 250 words describing your future goals. You can cut and paste into this field.)

Essay

Type or Paste Your Essay

Please include the applicant’s photo in your application submission. This high-quality photo should be a current senior portrait for your yearbook or a color passport (.jpg or .png).

Applicant Photo

Select File

Please attach two (2) letters of recommendation (.docx or .pdf).

Letter of Recommendaton

Select File

Letter of Recommendaton

Select File

Please attach copy of high school transcript (.pdf).

High School Transcript

Select File

As the Parent(s) or Legal Guardian(s) of the Applicant, I (We) agree to allow the photo of my/our son to be used in any Press Release related to this Scholarship Award, being presented to him by Alpha Phi Alpha Fraternity, Inc. Delta Psi Lambda Chapter and/or the George E. Hailey (GEH) Scholarship Endowment. In addition, the GEH Scholarship Endowment is also granted approval to use said photo (or other photos in which the student appears) in any future fund-raising events related to the GEH Scholarship Endowment.

Agreed to the above by Parent(s) or Legal Guardian(s) signatures

Parent/Guardian Printed Signature

Date

Consent of photo use

Parent/Guardian Printed Signature

Date

Consent of photo use

Your application has been successfully submitted

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