JWHAA Application Form

JWHAA Application Form

The Jameelah Wright Howard Achievement Award will be presented to girls and women who provide leadership to young girls and young women between the ages of 11-21 years old through mentoring and education. All winners will be notified in May 2024! Thank you for all you do!
Name

First NameLast Name
Email
example@example.com
Phone Number
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Information
Name of High School Attended
Name of College/University Attended
Year Graduated or Received GED
Ranking in Graduation Class
Latest GWA Percentile
Date Expected to Graduate or Receive GED

MonthDayYear
Date
Please describe a specific instance where you are mentoring another girl or woman to help them build self-confidence and self-esteem.
What challenges does your mentee(s) face? How do you provide support and guidance?
What impact does your mentorship have on them?
Are you a member of any organization in your school, work, or socially? Please provide information
Upload here your artwork, video, or supporting materials

Cancelof
Have you ever participated in a Systas 4 Systas, Inc. program, community service or volunteered with the organization? If so, please explain.

Financial Information
Are you a dependent of your Parents?

YesNo
Your Family's Joint Annual Income
Are you working? If yes, please provide details below
Have you tried applying for scholarships with other organizations previously?

YesNo
Please explain any help you may need to improve the mentorship that you are currently providing to your mentee(s).
Please describe what you will do with the cash prize if awarded the JWHAA grant.

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. ALL APPLICATIONS MUST BE RECEIVED NO LATER THAN MAY 1, 2024, 11:59 pm.
Applicant's Signature

Clear
Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
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