Monroe Alumnae Scholarship Application Form

OFFICIAL SCHOLARSHIP APPLICATION FORM
APPLICANT INFORMATION:
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Format: (000) 000-0000.
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a member of Delta GEMS?*

YesNo
If yes, NAME OF CHAPTER:
YEARS OF PARTICIPATION

2022-20232023-20242024-20252025-2026Not Applicable
SCHOOL AND COMMUNITY INFORMATION
Name of High School:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Graduation*

MonthDayYear
Date
GPA: *
Ranking in Graduation Class*
Honors/Awards received (listed in chronological order)/most recent first)*
Extracurricular Activities at school and offices held (listed in chronological order/ most recent first) *
Community/Church Organizations/Activities and offices held (listed in chronological order/ most recent first) *
List names(s) and locations(s) of colleges/universities to which you have applied: Name of School Location (Street Address, City/State/Zip Code): *
Proposed College Major: *
Official copy of the high school transcript with OFFICIAL school seal and official copy of ACT/SAT scores with OFFICIAL school seal.
Official copy of the high school transcript*

Cancelof
Official copy of ACT/SAT scores*

Cancelof

ESSENTIAL ITEMS:
NOTES*

Scholarships vary from year to year based on the Sorority fundraiser.Those candidates selected for the Scholarship Award will receive formal notification of their award.Scholarship Awards will be paid upon confirmation of THE SUBSEQUENT FALL University registration.PARTICIPATION IN DUAL ENROLLMENT CLASSES WILL NOT BE CONSIDERED FOR PAYMENT.
BEFORE SIGNING PLEASE ENSURE THAT ALL OF THE FOLLOWING ITEMS ARE ENCLOSED AS ATTACHMENTS TO YOUR APPLICATION.*

Official high school transcript with cumulative GPA and OFFICIAL school seals as of March 2026Official copy of ACT/SAT scores with OFFICIAL school sealTwo (2) signed letters of recommendation (original signature): 1. From the Principal, Counselor, or Teacher 2. From the organizations(s) verifying public service involvementTyped, 250 minimum word autobiography.

CERTIFICATION:

Please print this page, apply an original ink signature, and upload in the certification section on this page. E-signatures are not permitted.
I consent to my child’s application for the scholarship and understand, if awarded, the funds will be made payable to the student and/or the college/university and may be sent directly to the recipient. I certify that the foregoing statements are correct.
Signatures:
Parent/Guardian
Month, Date, Year
Student Applicant
Month, Date, Year
Signature: Principal or Counselor
Month, Date, Year
CERTIFICATION:*

Cancelof

FAILURE TO COMPLY WITH THESE INSTRUCTIONS WILL ELIMINATE THE APPLICATION FROM CONSIDERATION.

Note: All items must be submitted as one complete package. Incomplete packages will not be considered or returned. If there are questions regarding the application process, please contact the Scholarship Committee Chairperson, Ms. Votika Lynch by phone at (318) 791-6227 or through email at macscholarship1955@gmail.com and the Chapter President, Dr. LaTina S. Johnson 318.805.3296 or macpres@monroealumnae1955.org.
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*
Name of Applicant*

First NameLast Name
Date Signed by Applicant*

MonthDayYear
Date
Should be Empty:

Delta Sigma Theta Sorority Inc.