Thelma Berlack Boozer Scholarship Application

Thelma Berlack Boozer Scholarship Application

You will need three character reference letters
Date

MonthDayYear
Personal Data
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Address*

Street Address

Apt/Unit #

CityState

Zip Code
Mobile Phone Number*
Enter mobile phone number
Home Phone Number*
Enter home phone number
E-mail*
Enter E-mail Here

Family member(s) living in your household*

	Name	Age	Relationship to Applicant
Enter family member 1
Enter family member 2
Enter family member3
Enter family member 4
Enter family member 5

Are you or a member of your family related to a Board member of The Tau Omega Charitable Trust Fund, Incorporated or a member of Tau Omega Chapter, Alpha Kappa Alpha Sorority, Incorporated?

YesNoNot sure
Education, Community Involvement, Employment Data

Education*

	School Name	Date Entered	Date Completed
Elementary
Jr. High/Middle School
High School

Extra-curricular Activities (include offices held)*
Community Services Activities (include approximate hours)*
Work Experience*
Educational Goals*
Career Goals*

Name(s) of College(s) of your choice:*

	Name	Location	Has Admission Been Granted
Enter details
Enter details
Enter details
Enter details
Enter details
Enter details
Enter details
Enter details
Enter details

Financial Information

Student's Expenses*

	Yearly Estimate
Tuition and Fees
Room and Board
Books and Supplies
Personal Expenses (i.e. meals, transporation, clothing, recreation)
Incidentals

Student Expenses

If none for any category enter zero
Tuition and Fees*
Room and Board*
Books and Supplies*
Personal*
Incidentals*
Total Expenses*
Calculated value based on data entered
Student's Resources

If none for any category enter zero
Parent(s) Contribution*
Social Security Benefits*
Student's Contribution*
Veteran's Benefits*
Tuition Assistance Program*
I
Regent's Scholarship*
Pell Grant*
Other Grants*
Loans*
Other*
Describe other in the box below Explain any unusual financial circumstances
Total Resources
Calculated value based on data entered
Please explain any unusual financial circumstances*
Upload an official copy of your high school transcript.*

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References and Essay
Upload three character references as required. An acceptable reference letter should come from a teacher, religious leader, community person, employer familiar with the character of the applicant (not inclusive of family members). *Letters must include the person's position, address and telephone number.*

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Upload a two to three page essay introducing yourself to the Scholarship Committee. Make sure to indicate the scholarship for which you are applying.*

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Declaration

(typed signature required)
I declare that the answers given in this application are true to the best of my knowledge and belief. If an award is granted to me, I promise to answer letters relating to the scholarship promptly and to keep The Tau Omega Charitable Trust Fund, Incorporated informed of my current home and college address. I recognize that if I am not a U.S. citizen or permanent resident, I am not eligible for The Tau Omega Charitable Trust Fund, Incorporated Scholarship.

If you are unable to sign the form please type your name in the box below the signature.
Signature

Clear
Type your name if unable to sign
Submission Date

MonthDayYear
Should be Empty:

Thelma Berlack Boozer Scholarship Application

Personal Data

Education, Community Involvement, Employment Data

Financial Information

Student Expenses

Student's Resources

References and Essay

Declaration