Samuel Risby Memorial Scholarship
2026 Application
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Professional Headshot
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Gender
Male
Female
Ethnicity
Black/African American
White/European American
Asian
Hispanic/Latino
American Indian/Alaska Native
Native Hawaiian/Pacific Islander
Middle Eastern/North African
What Community College do you attend?
What is you GPA?
What is your Major?
Unofficial Transcript
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Resume of Leadership, Extracurricular Activities, Volunteer Services (1 Page)
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Letter of Recommendation from college faculty member.
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Letter of Recommendation from a community leader, church, or mentor.
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Proof of enrollment
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Video Prompt (5-7min) “Describe the challenges you have faced in pursuing your education and how those experiences have shaped your determination to continue your academic journey at a four-year institution. How do you plan to use your education to positively impact your future and your community?”
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What are your career goals and plans for the future? (250 words)
Acknowledgement Statement:By checking this box you acknowledge all of the information provided is accurate. False information will result in revocation of scholarship and prevention from applying to any future scholarships. By checking this box you allow the use of your information to be used and posted on social media platforms.
I Acknowledge
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