North Fulton Chapter of Mocha Moms, Inc. Scholarship Application Form

North Fulton Chapter of Mocha Moms, Inc. Post Secondary Scholarship Application Form
Who We Are

The North Fulton Chapter of Mocha Moms, Inc. is a community of mothers of color dedicated to supporting one another through all stages of motherhood. We are a chapter rooted in the North Fulton, Georgia area, committed to sisterhood, support, and community service. As a 501(c)(3) non-profit organization, we strive to make a tangible impact on our local community by fostering deep connections and supporting the educational aspirations of area youth.

Our Chapter's Scholarship

This year, we are proud to introduce our 1st Annual Scholarship Program. This award will recognize one graduating high school senior who demonstrates exceptional character, a commitment to uplifting their community, and a leadership style that fosters a spirit of belonging.

Award Amount: Individual scholarship awards up to $1,000

Eligibility & Our Commitment to Educational Excellence

To be eligible for this scholarship you must meet the following criteria:
- Academic Standing: Must have a cumulative GPA of 3.0 or above on a 4.0 scale.
- Geography/Membership: Open to high school seniors attending public high schools within the North Fulton community. We also welcome applications from children of current North Fulton Chapter members, regardless of their school's geographic location (provided the school is within the state of Georgia).
- HBCU Interest: While enrollment at a HBCU is not a requirement for this award, our chapter maintains a special interest in supporting the legacy of Historically Black Colleges and Universities and the students who choose to pursue their degrees at these historic institutions.
Important Requirements & Key Dates To celebrate the recipient and ensure the integrity of the award, all applicants must agree to the following:
1. Scholarship Luncheon & Official Presentation: The recipient is required to attend the North Fulton Mocha Moms Scholarship Luncheon on June 13, 2026, for the official award presentation.
2. Juneteenth Celebration: The recipient will be publicly recognized during the Johns Creek Juneteenth Celebration on June 20, 2026. Attendance is mandatory.
Media & Photo Release: By submitting this application, you grant the North Fulton Chapter of Mocha Moms, Inc. permission to use your likeness (photo/video) in chapter communications, social media, and local press to celebrate your achievement.

Submission Checklist Before you begin, please have the following ready:
- Unofficial High School Transcript
- Community Service and Leadership Record
- One Professional/Academic Letter of Reference
Deadline: All applications must be submitted by April 18, 2026, at 11:59 PM EST.

Questions: Please email northfultoncounty@mochamoms.org

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
Educational Information
Name of High School*
Principal's Name*

First NameLast Name
Principal's Email *
example@example.com
High School Counselor's Name

First NameLast Name
High School Counselor's Email
example@example.com
High School's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Academic Profile
Date Expected to Graduate*

MonthDayYear
Date
What are your post secondary education plans?*
GPA*
Class Rank
Please submit your unofficial high school transcript. *

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Please submit your reference letter here. *

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Extracurricular Involvement: Please list any school-based or community organizations, clubs, or teams you belong to and describe your role in each.*
Academic Honors and Awards: Please list any academic honors, awards, or recognitions you have received during high school. *
Commitment to Community Service: Please detail your involvement in community service and volunteer activities throughout your high school career. *
Essay

The North Fulton Chapter of Mocha Moms, Inc. is dedicated to creating a sense of community and fostering deep connections among the families we serve. As you prepare to graduate, we invite you to share how you have championed these same values within your own circles.Please reflect on your high school career and respond to the following:How have you used your leadership and commitment to service to build a community where every individual feels truly valued and supported? In your response, describe a specific project, role, or moment where you took the initiative to ensure that no one was left behind or overlooked. Finally, share what this experience taught you about a leader's responsibility to cultivate a spirit of belonging for everyone.

Parent and/or Caretaker Information
Name of Parent or Caretaker*

First NameLast Name
Relationship to Applicant*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name of Parent or Caretaker

First NameLast Name
Relationship to Applicant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Any additional information that you'd like to share?

By signing, I certify that all statements and information provided in this application are true and correct to the best of my knowledge. I understand that any deliberate misrepresentation may result in the denial of my application or the forfeiture of any award granted.

I further acknowledge and agree to the following requirements:

Attendance: I understand that the scholarship award is contingent upon my attendance at the North Fulton Mocha Moms Scholarship Luncheon (for the official presentation) and the Johns Creek Juneteenth Celebration (for public recognition).

Media Release: I grant the North Fulton Chapter of Mocha Moms, Inc. permission to use my name, likeness, and photograph in chapter communications, social media, and local press to celebrate my achievement.

I understand that failure to meet these attendance or media requirements may result in the revocation of the scholarship award.
Applicant's Signature*

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North Fulton Chapter of Mocha Moms, Inc. Post Secondary Scholarship Application Form

Applicant Information

Educational Information

Academic Profile

Essay

Parent and/or Caretaker Information