BCAC Scholarship Application

BCAC Scholarship Application
Type of Scholarship

L.E.A.DMemorial
Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Date
Age*
Gender*

FemaleMale
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
Primary Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Preferred Contact Method

Primary Phone NumberEmail Address
Parent/Guardian Information
Parent/Guardian #1*

First NameMiddle NameLast NameSuffix
Relationship*
(Ex. Father, Mother, Grandmother, etc.)
Parent/Guardian #1 Address same as applicant

Yes
Parent/Guardian #1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact number for Parent/Guardian #1 *

Area CodePhone Number
Parent/Guardian #2

First NameMiddle NameLast Name
Relationship*
(Ex. Father, Mother, Grandmother, etc.)
Parent/Guardian #2 Address same as applicant?

Yes
Parent/Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 Contact Number

Area CodePhone Number
Education
Name of High School*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expected Date of Graduation*

MonthDayYear
Date
Current GPA*
List the names of three (3) colleges or universities (in order of preference) to which you have applied. Please also confirm the current acceptance status. NOTE: if you are applying for the L.E.A.D. Scholarship, you must be accepted into and attend a Historically Black College or University (HBCU).*
Awards and Honors
List any award and/or recognition that have you received, along with the name of the organization(s) from which you received the award and/or recognition.

**You may attach additional pages as needed. Include your full name on any additional pages. An option to upload additional documents is included near the bottom of this application form **
List your high school clubs and memberships with month(s)/year(s), including leadership positions you hold/have held:*
List community and organizational memberships with month(s)/year(s), including leadership positions you hold/have held:*
SAT/ACT Score

Provide your SAT/ACT score below and upload supporting documentation. SAT and/or ACT scores are optional. If scores are provided, bonus points may be applicable.
SAT (combined score)
ACT (score)
Employment

List any employment history with month(s)/year(s), including the name of your employer, a contact person, your title, and the basic responsibilities of your job(s):
Company Name
Job Title
Dates of Employment
Contact Person
Phone Number

Area CodePhone Number
Responsibilities
Company Name
Job Title
Dates of Employment
Contact Person
Phone Number

Area CodePhone Number
Responsibilities
Community Service

List any community service/volunteer work you have done. Include the name of the company or organization, a contact person, the dates of service and the type of community service or volunteer work you performed.
Company/Organization Name
Date(s) of Service
Contact Person
Phone Number

Area CodePhone Number
Responsibilities
Company/Organization Name
Date(s) of Service
Contact Person
Phone Number

Area CodePhone Number
Responsibilities
Additional Uploads
Please upload any additional supporting documents for the Education, Awards/Honors, Employment or Community Service sections. Include your full name at the top of the uploaded file(s).

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Essay
Prepare and upload a narrative (containing at least 750 words) in which you discuss one of the following topics:
- Discuss the positive and negative impact of social media on you and/or those around you.
- Discuss a current event that has personally impacted you or about which you are passionate.
- Discuss what you believe to be the most important issue facing minority youth, why that issue is the most important, and make recommendations to effectively address that issue.
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Letters of Recommendation
Upload three (3) letters of recommendation written on official letterhead from individuals, excluding relatives, who have personally interacted with you through supervision, instruction or guidance. Each individual should be able to vouch for your character and/or your abilities/activities, and their contact information must be included for verification. Select individuals to provide your recommendation letters from the list below. Letters of recommendation written by relatives are NOT acceptable. NOTE: At least one recommendation must be from an academic official* (i.e. principal, teacher, or advisor)
- H.S. Principal*
- H.S. Teacher*
- H.S. Guidance Counselor/Advisor*
- Community Service Organization Personnel
- Minister, Pastor or Church Leader
- Civic Leader (i.e. Politician, Government Official, etc.)
- Mentor
- Employer
- Youth Club or Youth Group Leader
- Coach
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Certification
I hereby declare that each of the following statements is true. I will accept the decision of the Scholarship Committee of the Baltimore County Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated in connection with this application process. If selected to receive a scholarship award, I acknowledge that my receipt of the award is contingent upon my acceptance, enrollment and continuation at a college or university. I further acknowledge that if awarded a L.E.A.D. scholarship, I must be accepted into and maintain enrollment at a HBCU.

Failure to fully complete the application as instructed will result in my disqualification from the application process.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

BCAC Scholarship Application

Parent/Guardian Information

Education

Awards and Honors

SAT/ACT Score

Employment

Community Service

Additional Uploads

Essay

Letters of Recommendation

Certification