2026 SCHOLARSHIP APPLICATION PACKET

100
BLACK
MEN
OF ROME-NORTHWEST
GEORGIA, INC.
SCHOLARSHIP APPLICATION PACKET
100 Black Men of Rome-Northwest Georgia, Inc.
Service Area: Floyd, Polk, Gordon, Bartow, Paulding, and Chattooga Counties.

APPLICATION INFORMATION
100 Black Men of Rome-Northwest Georgia, Inc. will award academic scholarships to deserving male or female high school or college students from the Floyd, Polk, Gordon, Bartow, Paulding and Chattooga counties.
SCHOLARSHIP SELECTION:
Please check the box for the scholarship you are applying for. You may only select one:
The J.L. Vaughn Collegiate Excellence Scholarship ($1,000)
- For: Students currently enrolled in an accredited college, university, or technical school.
- Geographic Rule: Must have a permanent hometown address in our 6-county service area OR be enrolled in a college physically located within these counties.
The Greg Shropshire Emerging Leader Scholarship ($500)
- For: Graduating high school seniors.
- Geographic Rule: Must be graduating from a high school located within our 6-county service area.
CRITERIA
Each applicant must meet the following criteria to be eligible:
- The student must be a graduating high school senior (or graduate) from Floyd, Bartow, Gordon, Polk, Paulding, or Chattooga counties.
- The student must have demonstrated leadership ability and community involvement.
- Participation in a 100 Black Men program is strongly encouraged and highly recommended, though not required for eligibility.
- Two letters of recommendation: one must be written by a school representative (for high school seniors) or a faculty advisor (if already attending college or technical school).
- The student must have at least a 2.5 GPA.

SCHOLARSHIP APPLICATION FORM
1. Name:

First NameLast Name
Date:

MonthDayYear
Date
2. Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Telephone No.:
Format: (000) 000-0000.
4. Parents/Guardian:
5. Grade Point Average (GPA):
Rank in Class:
6. College/University You Plan to Attend (or are attending):
7. Intended Major:
8. School/Community Activities & Awards: (Please list these on your attached resume)
9. 100 Programs: List any 100 Black Men programs you have participated in over the past three years (list on resume).
10. Essay: On a separate 8.5 x 11 sheet of paper, submit a typed essay (250-500 words) explaining your career goals and how this scholarship could help you achieve them.
STUDENT CHECKLIST
Your application package MUST include the following:

A typed resume demonstrating your work, school activities, leadership, community/volunteer experience, and awards.A typed essay describing your goals (250-500 words).A brief statement regarding any special circumstances that would impact you attending college.Two letters of recommendation (one from a school representative or faculty advisor).High School Seniors: High school transcript and proof of college enrollment/acceptance letter.College Students: Current college transcript.High School Seniors: National Test Scores (SAT, ACT, etc.).The student and parent agreement forms completed and signed.
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AGREEMENTS AND CERTIFICATIONS
STUDENT'S AGREEMENT
1. I will be a full-time student as defined by my post-secondary institution.
2. Proceeds are to be used for tuition, fees, room, board, and books only.
3. I will obtain a letter verifying enrollment from the registrar's office.
4. I authorize the Committee to contact my faculty advisor/school for info if necessary.
Signature of Applicant:
Date:

MonthDayYear
Date
PARENT/GUARDIAN'S AGREEMENT
1. I have read and approved this application.
2. I have reviewed and agree with the student's agreement above.
Signature of Parent/Guardian:
Date:

MonthDayYear
Date
HIGH SCHOOL GUIDANCE COUNSELOR
(For High School Seniors Only)
Applicant ranks:
in a class of:
Overall GPA:
Verbal:
Math:
Total:
School Principal:
Counselor Signature & Seal:
DEADLINE: May 4, 2026

If you have any issues or questions, please email us at 100bmornwga@gmail.com , and you can learn more about our organization and its mission by visiting 100bmornwga.org
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APPLICATION INFORMATION