SCHOLARSHIP APPLICANT INFORMATION FORM
SCHOLARSHIP APPLICANT INFORMATION FORM 1 National Association of Historically Black Colleges and Universities Title III Administrators, Inc. www.hbcut3a.org Scholarship Applicant Information Form Personal Information Full Name: Enter last name here. Enter first name here. M.I. Date: Click to enter date. Last First M.I. Mailing Address: Enter street address or P.O. Box here. Apartment/Unit # Street Address (or P.O. Box) Apartment/Unit # Enter city here. Enter State initials here. Enter zip here. City State ZIP Code Phone: Enter primary 9-digit phone number here. Email: Enter primary email here. Educational Background College/University: Enter name of College/University. College/University’s Region: Choose an item. Major: Enter major here. Minor (Optional): Enter minor here. Anticipated Graduation Date: Click to enter a date. GPA (minimum 2.5 or equivalent required): Enter GPA. Campus Involvement, Community Service and Other Activities The responses to the following should include related activities that you have been involved in throughout your college life. 1. …
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SCHOLARSHIP APPLICANT INFORMATION FORM 1 National Association of Historically Black Colleges and Universities Title III Administrators, Inc. www.hbcut3a.org Scholarship Applicant Information Form Personal Information Full Name: Enter last name here. Enter first name here. M.I. Date: Click to enter date. Last First M.I. Mailing Address: Enter street address or P.O. Box here. Apartment/Unit # Street Address (or P.O. Box) Apartment/Unit # Enter city here. Enter State initials here. Enter zip here. City State ZIP Code Phone: Enter primary 9-digit phone number here. Email: Enter primary email here. Educational Background College/University: Enter name of College/University. College/University’s Region: Choose an item. Major: Enter major here. Minor (Optional): Enter minor here. Anticipated Graduation Date: Click to enter a date. GPA (minimum 2.5 or equivalent required): Enter GPA. Campus Involvement, Community Service and Other Activities The responses to the following should include related activities that you have been involved in throughout your college life. 1. List your honors, awards, and leadership/membership activities (including offices held). Click or tap here to enter text. 2. List your community and/or campus service activities. For each activity, include your role and number of hours you volunteered. Click or tap here to enter text. 3. List your extra-curricular activities and/or employment (including work-study and internships). Click or tap here to enter text. SCHOLARSHIP APPLICANT INFORMATION FORM 2 Military Service (Optional) Branch: Click here to enter text. From: Click to enter date. To: Click to enter date. Rank at Discharge: Click here to enter text. Type of Discharge: Click here to enter text. If other than honorable, explain: Click here to enter text. REMEMBER The deadline for the application packet is to be received via email no later than Friday, September 3, 2021. The completed application packet must be emailed to nahbcut3ascholarship@gmail.com.