Freedom & Empowerment Scholarship Application (2022-2023)
The information provided on this application will be used by the Freedom & Empowerment Scholarship Committee to select recipients for its scholarships. It is important that you give complete and accurate details to be sure your application is properly considered.
- Note -
To complete this application all applicants must submit the following to be considered for the scholarship: ACADEMIC DOCUMENTATION (Transcript or report card), PROOF OF AGE (Birth certificate, passport, government ID), ONE REFERENCE, and a RECENT PHOTO. Applicants seeking scholarship based on financial need will also need to submit proof of household income such as: Last year's tax return, W-2, or 4 recent pay stubs)
General Information
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Home Phone Number
*
-
Area Code
Phone Number
Mobile Phone Number
-
Area Code
Phone Number
E-mail
*
example@example.com
Do you have a student currently enrolled in a Pearson Online Academy School or Connections Academy?
*
Yes
No
How did you hear about the Freedom & Empowerment Scholarship
*
Email
Internet search (e.g. Google, Bing, MSN, etc.)
Newspaper article
Online advertisement
Postcard
Poster or flyer
Referred by a non-enrolled friend/family
Referred by an enrolled friend/family
Social media (e.g. Facebook, Instagram, Twitter, Pinterest, YouTube,etc.)
Teacher/counselor
SCLC member
Pearson Employee
Other
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Student Information
Student's Full / Legal Name
*
First Name
Middle Name
Last Name
Suffix
Nickname
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Federal Race and Ethnicity (Check all that apply)
*
Black/African American
Asian/Pacific Islander
Native American
Hispanic/ Latinx
White
Other
Student's grade level for the 2019-20 School Year
*
Grade level requested for 2020-21 School Year
*
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2019-2020 Schooling Information
Tell us a little about your previous schooling.
School 1
*
Type of School
*
Public
Charter
Private
Homeschool
Online
Other
Last Date of Attendance
*
-
Month
-
Day
Year
Date
School 2
Type of School
Public
Charter
Private
Homeschool
Online
Other
Last Date of Attendance
-
Month
-
Day
Year
Date
Why do you want to attend Pearson Online Academy?
*
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School/Community Activities/Work Experience/Sports/Awards/Etc:
List name of club, etc. and years of participation. If you volunteered, list the name of organization and the number of hours, weeks and years that you volunteered. If you worked, list the company, hours per week and length of time. Attach an additional sheet or resume if necessary.
List School Activities/ Offices Held
School Activities / Offices Held 1: (Non-Athletic)
School Activities / Offices Held 2: (Non-Athletic)
School Activities / Offices Held 3: (Non-Athletic)
List Community Service/ Volunteer Activities
Community Service / Volunteer Activities 1 (Non-Academic)
Community Service / Volunteer Activities 2 (Non-Academic)
Community Service / Volunteer Activities 3 (Non-Academic)
List All Athletic Participation
Athletic Participation 1
Athletic Participation 2
Athletic Participation 3
List All School/Community Awards and Honors
For example: CSF, GSE, National Honor Society, Girl/Boy Scouts, 4-H, Governor's Scholar, etc.
School / Community Awards and Honors 1
School / Community Awards and Honors 2
School / Community Awards and Honors 3
Employment
Please include: Company, Location, Position, Dates of Employment (mm/yy to mm/yy), Supervisor, Supervisor's Telephone Number
Employment 1:
Employment 2:
Employment 3:
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REFERENCES:
Please provide at least one professional reference, preferably an educator or community member who can provide a reference as to your character, interests, and past experiences.
Reference 1 Name (Relationship,Phone Number,email)
*
Submit Letter of Recommendation
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If for some reason a letter is unable to be provided, do we have permission to reach out to your reference directly? (Application will not be considered complete until reference is contacted)
*
Yes
No
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Need-based Scholarships Parent Financial Information (Not Required)
To be considered for need-based scholarships, you must provide a copy of your most recent tax return, W-2, or 4 recent pay stubs. In addition, please provide the information requested below. All information supplied by you will be treated as confidential. If you do not provide any financial information, your student will not be considered for need-based scholarships. If your financial circumstances change after you have submitted this form, please feel free to contact us.
Guardian's Information
Complete only the items marked with an asterisk (*) if you do not want your student to be considered for need-based scholarships. Please report earnings for the guardian who the student has lived with more than 6 months in the past twelve months. If the student lives with both guardians equally then provide answers about the guardian who provides the most financial support.
Guardian 1 Name
Guardian 1 Employer and Occupation
Guardian 1 Annual Income :
Guardian 2 Name
Guardian 2 Employer and Occupation:
Guardian 2 Annual Income :
Guardian(s) Highest Level of Education
*
Graduate school / Post-graduate training
College graduate (Bachelor's degree)
Some college or associate's degree
High school graduate
Not a high school graduate
I decline to state
Number of dependents in home:
First generation to attend college?
Yes
No
Please explain any unusual circumstances such as, child-support ending, emergency expenses, medical bills, seasonal work, unemployment, etc.
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Applicant's Essay
Select and answer a minimum of two (2) of the following questions. Answers should be a minimum of 100 words and can be submitted through the text box provided OR electronically.
Question 1: Share with us your personal and academic goals. How will the Freedom & Empowerment Scholarship aid you in pursuing those goals?
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Question 2: What three words best describes your personality? How will these attributes assist you with online learning?
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Question 3: What do you believe is the biggest issue facing the black community and why?
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Technology Information
This section will be used to determine if a student qualifies for a laptop, internet subsidy, and related software and hardware required for successful attendance while enrolled in Pearson Online Academy.
Student will have access to (Please select all that apply):
*
Phone (mobile/home phone)
Dedicated Computer
Internet connection that can support the activities of this virtual program
What type of home internet do you have?
*
Cable
DSL
Satellite
Dial-up
Other
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Documentation Submission
Please submit the following documentation to complete the scholarship.
Attach a recent picture: (This will be used when announcing the recipients.)
*
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Attach Proof of Age
*
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Official birth certificate, passport, or government provided identity card
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Attach Transcript/ Academic Document
*
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Submit recent unofficial school transcript, report card, or other academic records to ensure we can place the student in the appropriate grade/courses.
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Attach Financial Documents
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Submit most recent tax return, W-2, or last 4 paystubs.
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I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application or immediate termination of scholarship.
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