Jackson State University Memphis Alumni Chapter Scholarship Application

Jackson State University Memphis Alumni Chapter Scholarship Application
The Jackson State University Memphis Alumni Chapter Scholarship Program recongizes high school students, transfer students, or continuing upperclassmen from the Greater Memphis community, who will continue their education at Jackson State University.

APPLICANT QUALIFICATIONS:

• New freshman, upperclassmen or transfer student admitted to and/or attending Jackson State University.

• A minimum of a 2.5 grade point average (GPA) from most recent transcript.

• Permanent resident of Shelby, Tipton, and Fayette counties in Tennessee, Desoto, Tate, Marshall and Tunica counties in Mississippi, and Crittenden county in Arkansas.

INSTRUCTIONS:

Please read the following information before completing this application. The Scholarship Committee will not consider any application that is not complete as instructed below.

1. A completed application packet consists of:
1. A completed application
2. An official copy of your most recent transcript:
  - New Freshmen - High School Transcript
  - Upperclassmen/Continuing JSU Students - JSU Transcript
  - Transfer Students - Transfer College Transcript
3. Two (2) letters of recommendation on letterhead (non-relatives only, one letter must be from a teacher/professor, counselor or formal academic advisor, and only ONE letter can be from a current JSU Memphis Alumni Chapter member.)
4. A 500-word essay that answers the essay question “Why I Chose Jackson State University to Further My Education”
5. FERPA Consent form to release student information to verify enrollment for distribution of funds.
*Note: Students who receive awards during the Fall Semester and reapply for the Spring semester are only required to submit a completed application, current semester grades & FERPA Consent form (Items 3 & 4 are not required).

2. Application and all supporting documents must be submitted by each deadlines established for each semester. (Fall – August 1 & Spring – January 1) unless otherwise stated by the chapter.

3. Completed application packet can be submitted online and/or by mail. must be email, e-mail or hand deliver completed and unstapled application and all supporting documents in a singleenvelope to arrive by the above priority deadlines to:

If you have questions, please email scholarship@jsumemphis.org
SECTION A: APPLICANT INFORMATION
JNumber (If Known) *
Name *

First Name Middle Name Last Name
Birthday

Month Day Year
Date
Home Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
SECTION B: EDUCATION INFORMATION
FIRST TIME FRESHMAN:

This section should be completed by HIGH SCHOOL GRADUATES only.
High School
High School Address

Street Address

Street Address Line 2

City State

Zip Code
GPA
Date of High School Graduation
What is your proposed major/academic program?
CURRENT or RETURNING JSU STUDENTS

This section should be completed by CURRENT or RETURNING JSU STUDENTS.
Are you currently enrolled at Jackson State University?

Yes No
Classification

Freshman Sophomore Junior Senior
What is your current MAJOR/MINOR academic program?
Expected Graduation Date
Classification
TRANSFER STUDENTS

This section should be completed by TRANSFER students only.
What will be your transfer classification?

Freshman Sophomore Junior Senior
Transfer College/University
Transfer College/University Address

Street Address

Street Address Line 2

City State

Zip Code
GPA
Date of Graduation (If applicable):
What is your proposed major/academic program?
If yes, what is Your Classification?
SECTION C: TRANSCRIPTS

Please upload a copy or copies of your official transcript/s.
Official Transcript

Browse Files

Cancel of
Official Transcript (If you have more than one)

Browse Files

Cancel of
SECTION D: ACTIVITIES & INVOLVEMENT

List all school/community/church activities in which you have participated in, your level of participation and leadership roles listing any awards or honors received.

List All Activities

	Activities/Club	Length of Participation	Role in Group
1
2
3
4
5
6

SECTION E: Essay

Please attach a typed 500-word essay on the following topic:
“Why I Chose Jackson State University to Further My Education”
SECTION F: RECOMMENDATION LETTERS

Please upload two (2) letters of recommendations on letterhead from persons not related to you. We require that one letter must be from a teacher/professor, counselor or formal academic advisor at your school, and only ONE letter can be from a current JSU Memphis Alumni Chapter member.
Recommendation Letters

Browse Files

Cancel of
Application Checklist

This application becomes complete only after you have submitted:
Any Additional Documentation:

Browse Files

Cancel of
Signature

I, the applicant, certify that the information provided in this application is complete and accurate to the best of my knowledge.
Signature *

Clear
Today's Date *

Month Day Year
Date
I hereby affirm that I intend to enter Jackson State University. I understand that no scholarship funds shall be released until the scholarship committee receives a copy of my completed scholarship application packet.Additionally, I hereby grant permission for the use of my name and picture in any future publicity for the Jackson State University Alumni – Memphis Chapter’s scholarship program.
Signature *

Clear
Today's Date *

Month Day Year
Date

FERPA CONSENT TO RELEASE STUDENT INFORMATION
To: Jackson State University
Please provide information from the educational records of blanks* (Student Name).

to: Jackson State University Alumni - Memphis Chapter Scholarship Chair (person to whom the educational records will be released, and if appropriate the relationship to the student such as “parents” or “prospective employer” or “attorney”)

The only type of information that is to be released under this consent is:
___x__ Transcript
___x__ Financial Aid
___x__ Enrollment Status

The information is to be released for the following purpose:
__x__ Scholarship Consideration and Distribution of funds

I understand the information may be released orally or in the form of copies of written records, as preferred by the requester. I have a right to inspect any written records released pursuant to this Consent (except for parents’ financial records and certain letters of recommendation for which the student waived inspection rights). I understand I may revoke this Consent upon providing written notice to the University. I further understand that until this revocation is made, this consent shall remain in effect and my educational records will continue to be provided to Jackson State University Memphis Alumni Chapter for the specific purpose described above.
*

I agree to the above terms
Name
Student JNumber
Today's Date

Month Day Year
Date
Should be Empty:

Jackson State University Memphis Alumni Chapter Scholarship Application

SECTION A: APPLICANT INFORMATION

SECTION B: EDUCATION INFORMATION

FIRST TIME FRESHMAN:

CURRENT or RETURNING JSU STUDENTS

TRANSFER STUDENTS

SECTION C: TRANSCRIPTS

SECTION D: ACTIVITIES & INVOLVEMENT

SECTION E: Essay

SECTION F: RECOMMENDATION LETTERS

Application Checklist

Signature

FERPA CONSENT TO RELEASE STUDENT INFORMATION