NY Bussell Scholaship-Application-2022-1

Applications (males only) will be accepted from March 6 - April 28, 2023

(We will be awarding three young men from our community with a grand total of $2000)
First
Middle
Last
MAILING ADDRESS
State
Zip
CELL PHONE
Format: (000) 000-0000.
ALT. CELL PHONE
Format: (000) 000-0000.
EMAIL
example@example.com
CURRENT SCHOOL
CURRENT GPA
HERIOC MOVES
INCLUDE IN A BRIEF TYPED ESSAY THE FOLLOWING INFORMATION:
1.IF YOU ARE AN ACTIVE MEMBER OF LOCAL CHURCH, DESCRIBE YOUR CHURCH INVOLVEMENT.

2. DESCRIBE YOUR COMMUNITY INVOLVEMENT.

3. DESCRIBE YOUR ACADEMIC, CAREER GOALS, AND HOW WILL THIS SCHOLARSHIP HELP YOU ACHIEVE THOSE GOALS.

4.LIST ACADEMIC AND COMMUNITY ACHIEVEMENTS, HONORS, AND AWARDS RECEIVED.

5. CHOOSE ONE ACHIEVEMENT AND TELL US WHY IT IS ESPECIALLY MEANINGFUL FOR YOU.
SUCCESSFUL APPLICANTS WILL BE RECOGNIZED AT AN AWARDS PRESENTATION

BANQUET TO BE HELD AT THE ANNUAL MEN2Be GALA.

ALL APPLICANTS WILL RECEIVE NOTICE OF THE FINAL DISPOSITION OF THEIR APPLICATIONS AS SOON AS PRACTICABLE AFTER THE SELECTION PROCESS IS COMPLETED.

AWARDS ARE CONTINGENT UPON PROOF OF AN ACTIVE PLAN OF YOUR GOALS, ACCEPTANCE LETTER FROM A COLLEGE, UNIVERSITY, OR TECHNICAL COLLEGE.

ONE PERSONAL REFENCE AND ONE TEACHER REFENCE
APPLICATION INFORMATION RELEASE STATEMENT
THE INFORMATION PROVIDED IN MY APPLICATION IS, TO THE BEST OF MY KNOWLEDGE, COMPLETE AND ACCURATE. I GIVE PERMISSION FOR ANY COLLEGE, SCHOOL, OR INDIVIDUAL

TO RELEASE TO THE NY BUSSELL HUMANITARIAN SCHOLARSHIP COMMITTEE, Men2BeINC, And

ANY INFORMATION NECESSARY TO PROCESS MY SCHOLARSHIP.

I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO ENSURE THAT ALL SUPPORTING DOCUMENTS ARE RECEIVED BY NY BUSSELL HUMANITARIAN SCHOLARSHIP COMMITTEE
APPLICANT'S SIGNATURE

Clear
GUARDIAN'S SIGNATURE (IF UNDER 18 YRS OF AGE)

Clear
DATE

MonthDayYear
Date
REQURIED ITEMS TO BE INCLUDED WITH YOUR APPLICATION

**INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED**
COMPLETED APPLICATIONESSAYHEROIC MOVE ACTION PLAN AND/OR COLLEGE ACCEPTANCE LETTERMOST RECENT GPA VERIFICATION
File Upload

Cancelof
Should be Empty:

INCLUDE IN A BRIEF TYPED ESSAY THE FOLLOWING INFORMATION:

APPLICATION INFORMATION RELEASE STATEMENT

REQURIED ITEMS TO BE INCLUDED WITH YOUR APPLICATION