Omega Mu Omega Scholarship Application

Alpha Kappa Alpha Sorority, Inc.

Omega Mu Omega Chapter 2020-2021 Scholarship Application
PERSONAL INFORMATION
Applicant's Name:

First NameLast Name
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number:

Area CodePhone Number
Mobile Phone Number:

Area CodePhone Number
Email:
example@example.com
SCHOOL INFORMATION
High School Name and Address:
Counselor's Name:
Cumulative GPA:
PARENT/LEGAL GUARDIAN INFORMATION
Parent/Legal Guardian Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number:

Area CodePhone Number
Mobile Phone Number:

Area CodePhone Number
Email:
example@example.com
# of person under 18 living in the home:
# of siblings in college:
Do you have any family members who are members of Alpha Kappa Alpha Sorority, Inc.?

YesNo
If yes, please provide name, relationship, and chapter of each member:
REFERENCE LETTER(S)
Reference 1:

First NameLast Name
Title:
Upload Reference Letter 1:

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Reference 2:

First NameLast Name
Title:
Upload Reference Letter 2:

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References letter can be submitted by the individual on (website goes here)...
COLLEGE/UNIVERSITY INFORMATION
Colleges to which you have applied to and/or been accepted:
College Name and Location:
Acceptance:

YesNoPending
College Name and Location:
Acceptance:

YesNoPending
College Name and Location:
Acceptance:

YesNoPending
Which college do you plan to attend?
Is this a Historically Black College/University (HBCU)?

YesNo
What is your intended major?
For which Omega Mu Omega Scholarship are you applying?

Omega Mu Omega Freshman ScholarshipYvonne Cooper Watson Memorial ScholarshipOmega Mu Omega Continuing Student Scholarship
Have you applied for or received any other scholarship aid for the upcoming semester?

YesNo
If yes, from where?
Community/Extracurricular Activities (please include type, positions held, and dates):
Is there any other information you would like to have considered?
APPLICATION ATTACHMENTS

Please upload supplemental documents below:
Transcripts:

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Essay:

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PERMISSIONS AND SIGNATURE
Should I be selected as a scholarship recipient, I give permission for my name, photo, essay, and/or biographical information to be published by Alpha Kappa Alpha Sorority, Incorporated® Omega Mu Omega Chapter for use in print and electronic media (i.e. pamphlets/brochures, websites, and social media). I certify that all information contained herein is accurate and complete to the best of my knowledge. I understand that submitting false or otherwise inaccurate information is cause for forfeiture of any monetary award.
Applicant's Signature:
Date:

MonthDayYear
Date
Please return this application, your most recent official transcript, reference letter(s), and your essay as a complete package, no later than April 1, 2020 to:

Alpha Kappa Alpha Sorority, Incorporated®
Omega Mu Omega Chapter
Should be Empty:

Alpha Kappa Alpha Sorority, Inc.

PERSONAL INFORMATION

SCHOOL INFORMATION

PARENT/LEGAL GUARDIAN INFORMATION

REFERENCE LETTER(S)

COLLEGE/UNIVERSITY INFORMATION

APPLICATION ATTACHMENTS

PERMISSIONS AND SIGNATURE