Portia M. Parris Fellowship Youth Cohort Application

Awareness + Access = Success
Portia M. Parris Fellowship Youth Cohort Application

2023-2024
Dear Parent/Guardian:

The Portia M. Parris Fellowship welcomes the participation of you and your child in our youth enrichment program. To be eligible, an applicant must meet all of the following eligibility criteria by the application deadline. Follow the link below to self-certify that your student is an eligible candidate. Applicant Eligibility Criteria.

Once determined eligible, in order to be considered for this unique opportunity, your child must complete the following application.

Please note that spaces are limited for the program participation. For an application to be considered, all requested information and required signatures (guardian & student) must be completed.

If you have any questions, need special accommodations, or need a paper application; email us at ParrisFellows@NC-100.org or call 336.348.7980

Applications are due by Friday, September 29, 2023

If your child is submitting a hard copy application, your child’s guidance counselor must receive the completed document(s) by end of school day September 29, 2023.

Please ensure the application is complete and has all the requested information:

- (1) Letter of Recommendation

- (1) 2022-2023 Final Report Card

- One-page essay or 1-2 minute video essay

- All required signatures
Rockingham County School for 2023 - 2024 School Year*

High SchoolMiddle SchoolElementary School
Grade for 2023 - 2024 School Year*

3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade
Age*
Select One:*

FemaleMaleNon-Binary
Student Name*

First NameLast Name
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Home Phone Number

Area CodePhone Number
Student Cell Phone Number

Area CodePhone Number
Student Email
example@example.com
School Name*
Please provide full name of school instead of abbreviated version
School City
School County
Extra-Curricular Activities:
Talents & Hobbies:
What subject(s) interest you most that you would like to learn more about?*
Student T-shirt Size*
In a brief one-page essay or 1-2 minute video essay, please answer the following two questions: (1) "Who am I"? (2) What do you hope to gain from participating in the Portia M. Parris Fellowship? Below, please select which method you intend to use.*

One-page essay1-2 minute video essay
One-Page Essay Submission:
**If uploading document from computer source (below) place N/A in above section**
Parent/Guardian #1 Name*

First NameLast Name
Parent/Guardian #1 Email*
example@example.com
Parent/Guardian #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #1 Home Phone Number

Area CodePhone Number
Parent/Guardian #1 Cell Phone Number*

Area CodePhone Number
Parent/Guardian #2 Name*

First NameLast Name
Parent/Guardian #2 Email*
example@example.com
Parent/Guardian #2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 Home Phone Number

Area CodePhone Number
Parent/Guardian #2 Cell Phone Number*

Area CodePhone Number
Parent/Guardian: Do you agree to attend bi-monthly progress check meetings?*
Parent/Guardian: Can you commit to providing 15 hours of volunteer services throughout the 2023-2024 academic year.*
** hours can include chaperoning off-site field trips**
Upload: One-Page Essay

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Upload: 1-2 Minute Video Essay

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Upload: Student Report Card *

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Student Signature*

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Parent/ Guardian Signature*

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Please have your letter of recommendation sent to ParrisFellows@NC-100.org*
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Awareness + Access = Success

Portia M. Parris Fellowship Youth Cohort Application