Gamma Theta Lambda

Gamma Theta Lambda

Education Foundation, Inc.SCHOLARSHIP APPLICATION1. Name:

FirstMiddleLast

2(a). Address Line 1:

2(b). Address Line 2:

2(c). City:

2(d). State:

2(e). Zip:

3. Phone:() -

4. Email Address:

5. Date of Birth:

6. School Presently Attending:

7. School Address:Phone: () -

8. Guidance Counselor:Phone: () -

9. High School G.P.A.: out of (e.g. 3.27 out of 4.0)

10. SAT Scores:Math: Critical Reading: Writing:

11. ACT Scores:Composite:

English: Math: Reading: Writing:

All applicants are REQUIRED to submit a recent official copy of their transcripts to verify the above information.

12. List any academic honors or achievements received during high school.

13. List organizations that you participated in during high school. Include dates of participation and any positions held.

14. List any intramural or extramural sports you participated in during high school.

15. List any community/church affiliated involvement outside of school. Include any positions held and year of involvement.

16. Name Of Parent Or Legal Guardian:

FatherMother

A. Occupations Of Parent/Guardian:

FatherMother

B. Employer:

FatherMother

17. Names of Siblings: Ages:

18. List The Name(s) Of The College(s)/University(ies) To Which You Have Been OR HOPE TO BE Accepted:

Name of College:Location:

19. What Course of Study Will You Pursue in College?

20. What is Your Eventual Career Goal?

21. How Do You Intend To Pay For College Expenses?

22. Provide the names and addresses of three persons in responsible positions who can attest to your personal character, abilities, and qualifications. At least one of these references should not be associated with your school:

Person One:

NameAddress

Person Two:

NameAddress

Person Three:

NameAddress

23. On a separate sheet, please state in 100 to 200 words why you feel you should be considered for the Alpha Phi Alpha Fraternity scholarship. Please be sure to include this essay with your application.

I CERTIFY THAT THE INFORMATION CITED HEREIN, AND WHICH I AUTHORIZE YOU TO VERIFY IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE:

Signature of Applicant:Date:

Enter your name to serve as signature

Signature of Parent/Guardian: Date:

Enter your name to serve as signature

THE INFORMTION SUPPLIED BY THE APPLICANT WILL BE HELD IN THE STRICTEST CONFIDENCE AND WILL BE SHARED ONLY WITH THOSE PERSONS DIRECTLY INVOLVED WITH THE SCHOLARSHIP SELECTION PROCESS.

Return this form and all required documents via EMAIL or MAIL by MARCH 8, 2013

SCHOLARSHIP CHAIRMAN

GAMMA THETA LAMBDA

EDUCATION FOUNDATION, INC

P.O. BOX 1622WILMINGTON, DE 19899-5209Email: gtledfscholarship@gmail.com