Scholarship Application

Delta Sigma Theta Sorority, Inc. is an organization of college educated women committed to the constructive development of its members and to public service with a

primary focus on the black community.

Grand Rapids Alumnae Chapter P.O. Box 7066

Grand Rapids, MI 49510

Web: www.gracdeltas.org Email: grdeltas@gmail.com

Delta Sigma Theta Sorority, Inc. Grand Rapids Alumnae Chapter

Dear Applicant,

Thank you for applying for the Delta Sigma Theta Sorority, Grand Rapids Alumnae Scholarship. In order to be considered for a scholarship, you must meet the following eligibility criteria listed below and submit all required materials by the deadline. All scholarship applications are reviewed and determined by a scholarship selection committee comprised of both Delta and non-Delta community members.

ELIGIBILITY CRITERIA:

1. United States Citizen2. Earned a 2.5 or better on a 4.0 scale or 3.5 on a 5.0 scale3. Residency in Kent County

a. A senior graduating from a high school in Kent County

b. A sophomore or junior enrolled in a college, university or vocational institution in Kent County

c. A graduate or doctoral student enrolled in a college, university or vocational institution in Kent County

4. Accepted or currently enrolled in a two - or four - year college, university, vocational institution or graduate program

5. Available to participate in a personal interview

REQUIRED APPLICATION MATERIALS:

1. A completed typed application form

2. Two letters of recommendation (select from sources listed below):a. high school counselor or teacherb. non-profit agency that you have performed community service work within the last two yearsc. an individual, other than a family member, who is familiar with your accomplishments

3. A copy of the letter of acceptance to a college, university, vocational institution or graduate program that youplan to attend

4. Official sealed transcript mailed by the high school counselor or university directly to the Grand Rapid's Alumnae

Chapter post office box (must be postmarked by April 1 of the current year)

5. A professional resume

6. A typed personal essay: The essay should not exceed three (3) double spaced typewritten pages. This is youropportunity to explain your educational and career goals to the committee. Please include information such as: how this award will help you financially in reaching your potential goals. Explain how your leadership and past activities has an impact on the global society. How do you plan on sharing your academic success throughout your community? Please note, some awards are career pathway specific and require a declared major or mention of a proposed major (i.e. education, fine/performing arts, healthcare, etc.)

7. One wallet size headshot photo and signed photo release form (see pg.5)

SUBMISSION INSTRUCTIONS & DEADLINE:

Completed application packets must be submitted by USPS MAIL ONLY. Mailed packets must include all required

materials in one single envelope, postmarked by April 1. Mail all materials to the post office box below.

Grand Rapids Alumnae Chapter Attn: Scholarship Committee

P.O. Box 7066Grand Rapids, MI 49510

APPLICANT PERSONAL DATA

Middle Initial

Last Name

Mailing Address

Apt/Unit #

City

Zip Code

County

Phone Number

Email Address

Date of Birth (mm/dd/yyyy)

Are you a U.S. citizen?

Yes

No

Are you a registered voter?

Yes

No

State

First Name

Guardian(s) Full Name

Page 1

EDUCATIONAL INFORMATION

List the leadership roles that you have held during the past two academic years

List the honors and awards you have received during the past two academic years

List the extracurricular activities, during and after school, that you participate in

Have you applied for any other scholarships?

Yes

No

If so, please list the organization(s) and the amount

HIGH SCHOOL APPLICANT SECTION ONLY

High School Name

Graduation date (mm/dd/yyyy)

Class Rank (if available)

Cum GPA

ACT/SAT Score

Page 2

List up to four colleges, universities or vocal institutions to which you've applied. Please indicate acceptance with an asterick(*)

List your intended major and minor areas of study. Indicate "undecided" if none has been chosen.

Are you planning to enlist into the U.S. Military as an alternative to college?

Yes

No

If yes, which military branch?

COLLEGIATE APPLICANT SECTION ONLY

College/University Name

Anticipated graduation date (nm/dd/yyyy)

Classification

Cumulative GPA

List your declared major and minor areas of study. If undecided, please explain why and briefly explain your career goals.

Major:

Minor:

Degree to be conferred:

Undecided explanation (if applicable):

Page 3

CERTIFICATION

My statements on this form and any attachments are true, complete and correct to the best of my knowledge and belief. I understand that falsification of any of my answers will lead to the rejection of my application.

Yes

No

Applicant Signature and Date

Guardian Signature and Date (required for high school applicants only)

Completed application packets must be submitted by USPS MAIL ONLY. Mailed packets must include all required materials

in one single envelope, postmarked by April 1 of the current year. Mail all materials to the address below.

Please note that all scholarship disbursements are sent directly to the institution of higher learning on behalf of the student.

Grand Rapids Alumnae ChapterP.O. Box 7066

Grand Rapids, MI 49510Web: www.gracdeltas.org | Email: grdeltas@gmail.com

Page 4

Photography/Video Authorization and Release Form

I/We, (“Parent/Guardian”), as parent(s) or legal

guardian(s) of , give permission for the Grand Rapids

Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated (the “Chapter”) to publish on the

Internet or media still photographs or moving images, including, if applicable any sound recordings

accompanying the images (“Images”) taken of my child at Scholarship/solid Gold award activities

without payment or any consideration and without notifying me.

I/We understand and agree that these Images will become the property of the Chapter, which shall

have complete ownership of the Images. I hereby irrevocably authorize the Chapter

to publish or distribute these images for the purpose of publicizing the Chapter's scholarship

programming and for any other lawful purpose. In addition, I waive any right to inspect or approve

the finished product wherein my child's likeness appears. Additionally, I waive any rights to royalties

or other compensation arising out of or related to the use of the Images.

I/We hereby hold harmless and release and forever discharge the Chapter and any of its officers

and members; Delta Sigma Theta Sorority, Incorporated; its officers; National Executive Board;

employees; members; representatives; agents; and assigns from any and all claims, costs, suits,

actions, judgments, and expenses which my child, his/her heirs, representatives, executors,

administrators, or any other persons acting on his/her behalf have or may have by reason of the

use of the Images. This release specifically includes, without limitation, a complete release and

discharge of any liability by virtue of any editing, distortion, alteration, or optical illusion,

whether intentional or otherwise, that may occur or be produced in the taking of or editing of said

Images, unless it can be shown that such was maliciously caused, produced and published solely

for the purpose of subjecting my child to conspicuous ridicule, scandal, reproach, scorn and

indignity.

"I I/we hereby certify that I/we are the parents/guardians of __________________,

and do hereby give my/our consent without reservation to the foregoing on behalf of my/our child."

Applicant Signature and Date

Guardian Signature and Date (required for high school applicants only)

Page 5