TCMDAC Scholarship Application Form

Tri-County (MD) Alumnae Chapter Delta Sigma Theta Sorority, Inc. Scholarship Application Form

Application Deadline - March 31, 2021
Read and follow the instructions carefully prior to submitting your application. (TCMDAC Scholarship Application). All winners will be notified on or before the May 30, 2021.
Read and Understand the instructions. *

Yes, I have
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
SCHOLARSHIP SELECTIONS AND CRITERIA

You may apply for multiple scholarships. Place a check next to ALL applicable scholarships for which you wish to apply and provide ALL supporting documentation.
TCMDAC Scholarship Options (Check All that Apply):

ELVEAR B. JOHNSON (Ph.D.) SCHOLARSHIP: Education, Liberal Arts, STEM EDUCATIONAL PROGRAM SCHOLARSHIP: Delta GEMS or EMBODI COLLEGE OF SOUTHERN MARYLAND (CSM) SCHOLARSHIP TRI-COUNTY MARYLAND SCHOLARSHIP CAREER/VOCATIONAL/TECHNICAL SCHOLARSHIP BOOK SCHOLARSHIP
I. Applicant Information:
Full Name *

First Name Last Name
Date of Birth: *

Month Day Year
Home Address : *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Cell Phone Number : *

Area Code Phone Number
E-mail : *
Where the confirmation will be send to
Gender: *

Male Female
Is your Mother a member of the Tri-County (MD) Alumnae Chapter ? *

Yes No
Ethnic Origin:

Hispanic Non-Hispanic Not Indicated
Race? (Choose one or more):

White Black or African American Asian American Indian or Alaskan Native Hawaiian or Other Pacific Islander Non-Resident Alien
Major Area of Study:
Please indicate what is your major are of study
II. High School Information:

(Required by High School Applicants Only)
High School Attended:
School Address :

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
School Counselor Name:
Prefix First and Last Name
Counselor Phone Number:
Prefix First and Last Name
Counselor Email Address:
Prefix First and Last Name
Expected Graduation Date:

Month Day Year
Date
Most recent cumulative GPA:
Are you a participant of TCMDAC’s Educational Programs? *

Yes No
If Yes, Please specify:
III. College School Information:

(Required by Collegiate Applicants Only)
Name of College Institution:
School Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Expected Graduation Date:

Month Day Year
Date
Most recent cumulative GPA:
IV. Family Information:

(Required by Applicants under 18 years of age)
Name of Parent(s)/Legal Guardian:

First Name Last Name
Home Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Telephone Number:

Area Code Phone Number
Cell Phone Number:

Area Code Phone Number
V. Honors and Awards :

List all honors and awards received during high school. Please include a brief description of the honor(s)/award(s)received. (Use additional sheets as needed.) EXAMPLE: Most Valuable Player - Basketball (2019); Principal's Honor Roll (2018-2019)
Name of Award(s) or Recognition(s):
List Name of EACH award and include Date Awarded in parenthesis. Separate awards using a semi-colon (;).
VI. EXTRACURRICULAR ACTIVITIES

List all extracurricular activities (school and community), including academic related internships and work study jobs, that you have participated in during high school. Please include a brief description of the activities, position(s) held, duties and dates involved. EXAMPLE: National Honor Society President (2020-2021); Jack and Jill Teens (2015-2021)
List Activity/Job/Community Service:
List Name of EACH activity and include Leadership positions held and Date (To/From) parenthesis. Separate activities using a semi-colon (;).
VII. POST-SECONDARY INSTITUTION INFORMATION

List the post-secondary institution (college/university/technical or vocational institution)to which you have applied for fall admission. EXAMPLE: Howard University (Washington, DC -Applied); CSM (Leonardtown, MD-Accepted); Lincoln Tech (Denver, CO-Accepted)
College/University/Vocational School *
List Name of EACH College/University/Vocational School and include city and state in parenthesis. Indicate whether you applied or were accepted. Separate institutions using a semi-colon (;).
Proposed Major or Career Interest: *
VIII. ATTACHED DOCUMENTS

Transcript(s); Test Score(s); School Recommendation; Community Service Recommendation; Essay; Color Photograph; Copy of Acceptance Letter
A typed one-page essay on: why you chose education, science, technology, engineering or math as a career choice; or a one-page essay on the impact of TCMDAC Educational Program; or a one-page essay describing a community service project. (Maximum of one typewritten page, double spaced, 12-pt font).
ESSAY *

Browse Files
Load Essay Here Cancel of
SCHOOL RECOMMENDATION *

Browse Files

Cancel of
COMMUNITY SERVICE RECOMMENDATION *

Browse Files

Cancel of
IX. PHOTO RELEASE
As the parent/guardian of the applicant, I hereby grant the Tri-County (MD) Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated the unrestricted right and permission to use and re-use my child’s name and likeness in any and all publications, including photograph, television broadcast, video recording, internet sites, audio-recording or any other form of electronic or print communication (the Promotional Materials), for its own purposes without payment or any other consideration to me or my child, in perpetuity. I understand and agree that any material produced using my child’s likeness is the property of TCMDAC.
SCHOOL OR GRADUATION PHOTO

Browse Files
No proofs or personality photos. Include a professional head shot. Cancel of
Parent/Legal Guardian (Print Name):
Signature

Clear
X. CERTIFICATIONS
Please indicate by your signatures (original signatures only) below that you certify that the statements in this application are correct.

I certify that all information provided is true, complete to the best of my knowledge, and that you are not the child or step-child of a member of the Tri-County (MD) Alumnae Chapter of Delta Sigma Theta Sorority, Inc. I give TCMDAC permission to verify any information contained in my scholarship package, as necessary. I understand that misrepresentation of any information or the submission of inaccurate or incomplete information will result in disqualification to be considered for a scholarship or forfeiture of any award that I may receive.

I understand that if the applicant is awarded a scholarship, the funds will be made payable and sent directly to the post-secondary institution once proper verification document(s) have provided to Tri-County (MD) Alumnae Chapter of Delta Sigma Theta Sorority, Inc.
Applicant (Print Name):
Applicant Signature:

Clear
Parent/Legal Guardian (Print Name):
Parent/Legal Guardian Signature:

Clear
*Please note: If a photo release is not provided, the recipient cannot be photographed in group pictures. The pictures will be published.
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Tri-County (MD) Alumnae Chapter Delta Sigma Theta Sorority, Inc. Scholarship Application Form

SCHOLARSHIP SELECTIONS AND CRITERIA

I. Applicant Information:

II. High School Information:

III. College School Information:

IV. Family Information:

V. Honors and Awards :

VI. EXTRACURRICULAR ACTIVITIES

VII. POST-SECONDARY INSTITUTION INFORMATION

VIII. ATTACHED DOCUMENTS

IX. PHOTO RELEASE

X. CERTIFICATIONS