Monroe County NAACP Scholarship + Educational Materials Grant Application Form

Monroe County NAACP Scholarship

Please complete this form in its entirety to be considered for a scholarship awarded by the Monroe County NAACP with the generous support of the IU Credit Union or a books and educational materials grant made possibly by the McCluskey family.
Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a U.S. citizen? (Please note that you do NOT have to identify as a U.S. citizen to apply).

YesNo
List your current high school, college, or university.*
Cumulative GPA*
If you are currently a college student, choose your current status:

rising sophomorerising junior
Please list any academic awards and/or honors you have received.*
Please list any extracurricular activities including sports, student organizations and initiatives, etc. Include leadership positions you've held or currently hold.*
List any community service, community organizational affiliations or awards you have received.*
What are your future goals? How will attaining higher education help you achieve those goals?*

Parental Information

Please complete this portion if you are under 18 years of age.
Name of Parent/Guardian

First NameLast Name
Email Address
Phone Number

I CERTIFY THAT ALL STATEMENTS OR INFORMATION I HAVE PROVIDED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY DELIBERATE MISREPRESENTATION FOUND IN THIS APPLICATION MAY BE CAUSE FOR THE APPROVAL OF THIS APPLICATION AND MAY PROHIBIT ME FROM APPLYING AGAIN IN THE FUTURE.
Applicant's Signature

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Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
Should be Empty:

Monroe County NAACP Scholarship