2025 Merritt Johnson Juneteenth Scholarship Form

2025 Merritt Johnson Juneteenth Scholarship Application

God's Blessings Plan & Anthem Blue Cross Blue Shield
Graduating High School Seniors:

It is with great pleasure that God's Blessings Plan, in partnership with Empire Blue Cross Blue Shield, support the educational goals of the youth in Suffolk County. As an expression of our commitment to the youth, we are offering two (2) $1,000 scholarships to African American graduating high school seniors residing in Suffolk County who has plans to continue their post-secondary education by attending a vocational/training institute, Junior College or College/University of their choice. You must have a minimum GPA of 2.5 to be eligible for this award. Selection will be based on financial need, leadership and service. The award will be presented to a student who is using their talents to make a positive change within Suffolk County and/or exemplary commitment and service to their family or faith community. Scholarship funds may only be utilized to pay tuition, fees, room and board, books and/or meal plan and will be disbursed by check to the post-secondary institution via certified mail. We congratulate you on your successes thus far and celebrate your dedication to your education and academic achievements.

If you plan to submit an application for consideration, please review the following information. All candidates must submit:

1. An official copy of your high school transcript that notes your GPA

2. Copy of acceptance letter to College/Vocational School

3. At least two letters of recommendation, including one (1) from a teacher or school administrator

4. A completed scholarship application. Incomplete applications will not be considered.

5. A double-spaced typed essay of no more than 500 words to address the following:
“While reflecting on Juneteenth as a national holiday, discuss how you plan to contribute to the uplifting, encouragement and support of the black community.”

Deadline for submitting all requested materials must be post marked or emailed by:

Friday, May 30th, 2025

Applications can also be submitted via email at info@GodsBlessingsPlan.org

For any questions regarding the scholarship requirements, please contact:
Kiora Johnson (800) 243-8961

I. Personal Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
SSN (last four #)*
Gender
African-American*
Are you a resident of Suffolk County?*
Nonresidents of Suffolk County are ineligible for this scholarship
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell Phone:*

Area CodePhone Number
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian's Cell Phone:*

Area CodePhone Number
Name of High School*
Graduation Date*

II. Academic & Extracurricular Activities
High School GPA*
GPA must be at least 2.5.
Class Rank
SAT Score*
ACT Score*
List community service or exemplary family or faith contributions*

0/500
List scholarships received to date*

0/500
In the space below give a summary of your personal goals.*

0/500

III. Future Plans
College/Vocational School you plan to attend*
Have you been accepted*
Address of Institution*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Number of Institution*

Area CodePhone Number
Alternate Telephone Number of Institution*

Area CodePhone Number
Planned Major concentration and why*

0/250

IV. Financial Statement

Please Note: An incomplete budget will mean that your application cannot be considered. Show total family income and expenses.
1st Year Estimated Expenses:
Tuition and Fees*
Housing and Books*
Other Expenses*
Financial Resources:
Your Earnings*
Family's Earnings*
Other Income*
Brief Statement on Financial Need*

0/500

Attachments:
Copy of High School Transcript *

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Copy of acceptance letter to College or Vocational School*

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First Reference Letter*

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Reference letter must be written on a letterhead from a teacher or school administrator and must be signed. A phone number or email must accompany the reference letter. Cancelof
Second Reference Letter*

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Reference letter must be signed. A phone number or email must accompany the reference letter. Cancelof
Essay*

Browse Files
Double-spaced typed essay of no more than 500 words to address the following: “While reflecting on Juneteenth as a national holiday, discuss how you plan to contribute to the uplifting, encouragement and support of the black community.” Cancelof
Other

Browse Files
Use this to include any additional documentation you feel will assist in the selection process. Cancelof

Certification and Permissions Please Read and Sign
I hereby affirm that the information contained herein is true and correct. I hereby grant permission to God's Blessings Plan to verify such information and upon request to release information to the donor or donors of the Merritt Johnson Juneteenth Scholarship.

I understand that receipt of this scholarship grant may only be utilized to pay tuition, fees, room and board, books and/or meal plan and will be disbursed by check to the post-secondary institution via certified mail. Falsification of any information or failure to meet these requirements will result in the termination of my scholarship and I will be obligated to return any grant monies already received.

I hereby grant and assign God's Blessings Plan the right to use my biographical information, essay response, and my image to publicize my nomination and/or receipt of this scholarship award, and to promote the goals of the scholarship, for editorial, trade, advertising or any other purpose and in any manner and medium, including website, internet and television promotion.

I also consent to have a copy of my application and all supporting materials retained indefinitely by God's Blessings Plan.
Applicant's Signature*

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Date of Signature*

MonthDayYear
Date
Parent/ Guardian Signature*

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Date of Signature*

MonthDayYear
Date
Please verify that you are human*
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2025 Merritt Johnson Juneteenth Scholarship Application

I. Personal Information

II. Academic & Extracurricular Activities

III. Future Plans

IV. Financial Statement

1st Year Estimated Expenses:

Financial Resources:

Attachments:

Certification and Permissions Please Read and Sign