BK Scholarship Application Form

Brothers Keeper Mentorship, Scholarship Application (2022-2023), for Shelby School of Esthetics student only.

The information provided on this form will be used by the Brothers Keeper Mentorship Committee to select recipients for scholarships. It is important that you give complete details concerning your career plans, activities and financial information. You must be accepted and enrolled at SSE to be considered!
BASIC INFORMATION
Student's Full / Legal Name*

First NameLast Name
Student ID:*
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student Phone Number*

Area CodePhone Number
Student E-mail*
Gender
Academics
Academic GPA of a 2.0*
Schools to which you are applying
School 1
Major(s) You Are Considering

In order of preference, list the major(s) you are considering (Very important for scholarship eligibility).
Major 1
Estimated cost
School Type & Estimated Cost
Please Select
PERSONAL DATA:
High School(s) Attended
REFERENCES:

Please list one educator and at least one community person who would recommend you for a scholarship. Please do not list the person who completes a scholarship recommendation for you.
Reference 1 Name (Position,Phone Number. email)
Reference 2 Name (Position,Phone Number, email)

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.
School Activities
Work Activities
Church Activities
Community Service / Volunteer Activities 1 (at school)
Community Service / Volunteer Activities 2 (outside of school)
Community Service / Volunteer Activities 3 (outside of school)
Will you be participating in Medical Advanced Training?

YesNo
Travel Experience or Unusual Experiences (study abroad, etc.)
School / Community Awards and Honors 1 (no matter how small) CSF, GSE, National Honor Society, Girl/Boy Scouts, 4-H, Governor’s Scholar, etc.
School / Community Awards and Honors 2
School / Community Awards and Honors 3
EMPLOYMENT 1: List past and present work and length of time employed.
EMPLOYMENT 2: List past and present work and length of time employed.

Please provide general income information
Income Amount :
Please explain any unusual circumstances such as, child-support ending, emergency expenses, medical bills, seasonal work, unemployment, etc.

SCHOLARSHIP RECEIVED TO DATE
AMOUNT 1
AMOUNT 2
STUDENT STATEMENT: In a few sentences, describe yourself and 1. What was the most difficult event you have encountered in your life, and what did you do to overcome it? 2. Name a person who has inspired you to further your education. And why it meant so much to him/her? .*
Thank you for applying...

We will contact you soon!

Brothers Keeper Mentorship, Scholarship Application (2022-2023), for Shelby School of Esthetics student only.