2025 ICF Scholarship Application

2025 Scholarship Application

Current Undergraduate
OFFICIAL TRANSCRIPT - Must be sent via U.S. Mail and RECEIVED BY APRIL 30, 2025. Document should be mailed to:

The Ivy Centennial Foundation, Incorporated
ATTN: ICF Scholarship Chair
10736 Jefferson Blvd. #635
Culver City, CA 90230
I. PERSONAL INFORMATION

Legal Name of Applicant
Today’s Date

MonthDayYear
Date
Do you have a family member that is affiliated with or a member of the Ivy Centennial Foundation or Mu Lambda Omega Chapter of Alpha Kappa Alpha Sorority, Inc.?

YesNo
Name*

First NameMILast Name
Permanent Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.
Alternative Phone
Please enter a valid phone number.
E-mail Address (required)
example@example.com
Date of Birth

MonthDayYear
Date
Race: Please check (optional)

African American or BlackWhite (Not Hispanic)AsianNative AmericanLatinxNative Hawaiian/Other Pacific IslanderOther
Gender (Optional)

MaleFemaleOther
Educational Status/Category (Check all that apply)

Undergraduate - HBCUUndergraduate - STEM MajorUndergraduate - Business MajorUndergraduate - Health Major
Current School Name
Major:
III. WORK AND COMMUNITY PARTICIPATION
List all work and volunteer/community participation over the last two years:

Work Experience

	Name of Employer	Position/Title	Dates of Employment	# of Hours Per Week
1
2
3

Volunteer Work/Community Service

	Name of Organization	Number of Hours	Supervisor’s Name	Supervisor’s Number
1
2
3

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PERSONAL SIGNATURE FORM
Please review your scholarship application responses and sign your name below. Your signature will confirm the information provided on this application is accurate and true. The signature will also authorize your school/academic institution to release information for consideration of the scholarship.

Please note: If any information provided on this application is deemed inaccurate or false, the Ivy Centennial Foundation, Incorporated reserves the right to disqualify your application.
Applicant Name (please print)
Applicant Signature (Required)*

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Date

MonthDayYear
Date
Parent/Legal Guardian Name - If applicant is under 18 (please print)
Parent/Legal Guardian Signature (if student is under 18)

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Date

MonthDayYear
Date
Media Release Consent – Applicant Signature Parent/ Legal Guardian Signature (if student is under 18)*

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Date

MonthDayYear
Date
Media Release Agreement
I hereby irrevocably consent without royalty or other compensation of any kind, to the use, for any lawful purpose, by the Ivy Centennial Foundation (ICF) of my name, voice, and any portraits, likeness, pictures, images, video, film and photographs of me (hereinafter ‘Images”) taken by or on behalf of the Ivy Centennial Foundation (ICF) and reproductions of the same in any form, in any medium, including but not limited to the Internet and social media websites, hereby releasing the Ivy Centennial Foundation (ICF) from all liability arising from use of Images including what I might deem misrepresentation of me by virtue of distortion, optical illusions or faulty mechanical reproductions. I agree that all such Images whether plates, transparencies, negatives, film, video, audio, electronic, digital, and/or any medium now or hereafter utilized connected therewith are and shall remain the property of the Ivy Centennial Foundation (ICF) and if requested, I will execute any additional agreements to evidence these rights. I further agree to the use of statements made by me about the Ivy Centennial Foundation (ICF) and its various service projects and programs. I acknowledge that this release constitutes the entire understanding with the above parties, all prior understandings, if any, being merged herein.
Signed:

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Date

MonthDayYear
Date
Print Name:
Should be Empty:

2025 Scholarship Application

I. PERSONAL INFORMATION

III. WORK AND COMMUNITY PARTICIPATION

UPLOAD 500 WORD ESSAY

PERSONAL SIGNATURE FORM

Media Release Agreement