Delta Sigma Theta Sorority, Inc.
Savannah Alumnae Chapter
Scholarship Application Form 2016
Scholarships Available:
4 Academic scholarships in the amount of $2,000.00 each
1 Community service scholarship of $1,000.00
Criteria
Academic Scholarship
 GPA of 89 on a 100 point scale or 3.5 on a
4.00 scale
 Successfully passed all exit exams at the time
of application submission
 Submit SAT or ACT Scores
 Proof of College/University acceptance
 Demonstrated financial need
 Submit a current academic résumé
 Submit one letter of recommendation
 Submit Essay (use enclosed sheet)
 A single female with no dependents
 Demonstrated leadership ability
Community Service Scholarship
 GPA of 80 on a 100 point scale or 3.0 on a
4.00 scale
 Proof of College/University acceptance
 Documented community service of 100 or
greater hours (Supporting
documentation must be on official
stationary or bear an official stamp)
 Submit a current résumé
 A single female with no dependents
 Demonstrated leadership ability
 Letter of recommendation
 Submit essay
Application Deadline: FEBRUARY 8, 2016
Delta Sigma Theta Sorority, Inc.
Savannah Alumnae Chapter Scholarship Application Form
(Please type or print in Black ink)
DATE: _________________________________
Scholarship Applied for: (Select only one. Applications that do not specify a scholarship type will
be disqualified) Academic: _____ Community Service: _____
Name: _________________________________________________________________
Last
First
Middle
Address: ________________________________________________________________
Street
City
State
Zip Code
Date of birth: ______________ Home telephone:(___) ___ -____ Cellular: (__) ____- ____
Email address: ___________________________________________________________
Name of High School: ___________________________________________
Date of Graduation: ________________________________________________________
Month
Date
Year
Have you been accepted at a four-year college or university? Yes_____ No____
List the name of the institution you plan to attend: _______________________________
Date of entrance: ______________________
List, in detail, your community activities and public service in and out of school:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
List extra-curricular school activities, including any offices held:
_______________________________________________________________________
_______________________________________________________________________
List academic awards or honors earned: _______________________________________
_______________________________________________________________________
Tell us about your interests and educational plans: ______________________________
_______________________________________________________________________
_______________________________________________________________________
Have you received any financial assistance at this time? If so, indicate the source(s) and
specify the amount: ________________________________________________________
________________________________________________________________________
Student Biographical Information
Father’s Name: ____________________________________________________________
Home Address: ____________________________________________________________
Mother’s Name: ___________________________________________________________
Home Address: ____________________________________________________________
Parent’s Occupation (job titles):
___________________________________
Father
___________________________________
Mother
Guardian’s Name and Occupation: _________________________________________________
Address: __________________________________________________________________
Sisters and Brothers:
(Name)
(Age)
(Name)
(Age)
Your career plans: _________________________________________________________
_________________________________________________________________________
Will your parents assist you financially in continuing your education? Y__ N__ Some__
If so, how much additional assistance do you feel you will need to continue?
_______________________________________________________________________
Please check the range of your family’s income:
( ) $10,000 - 15,000
( ) $33,000 – 37,000
( ) $57,000 – 63,000
( ) $15,000 – 21,000
( ) $37,000 – 43,000
( ) $63,000 – 67,000
( ) $21,000 – 27,000 ( ) $27,000 – 33,000
( ) $43,000 – 53,000 ( ) $53,000 – 57,000
( ) $67,000 – 72,000 ( ) $72,000+
The applicant certifies the above information to be true and correct.
___________________
Date of application
__________________________________
Signature of applicant
Letter of Recommendation Information
(Please provide the following information about the person writing your letter of
recommendation)
Name: _______________________________________________________
Address: ________________________________________________________________
Telephone no._________________
Years known to applicant: _______________
In what capacity does this person know you (i.e. teacher, counselor, volunteer
coordinator)?
______________________________________________________________________________
______________________________________________________________________________
Your letter must come from a person who can speak to either your academic ability (if
applying for the academic scholarship) or your community service (if applying for the
community service scholarship). A letter will be considered strong if it contains specific
information about your strengths, skills and talents as an academic scholar or volunteer.
The letter of recommendation may not come from a family member.
The letter of letter recommendation must arrive on official letterhead.
The letter of recommendation must be presented in a sealed envelope that bears the letter
writer’s signature over the seal of the envelope (forged letters will result in automatic
disqualification).
The letter should be addressed to: Delta Sigma Theta Sorority, Inc.
Savannah Alumnae Chapter
Scholarship & Awards Committee
THIS FORM MUST ACCOMPANY YOUR APPLICATION
Essay
Please discuss the following prompt in 300-500 words or less.
The lessons we take from failure can be fundamental to later success. Recount an
incident or time when you experienced failure. How did it affect you, and what did you
learn from the experience?
Please type using Times New Roman in 12-point font on a separate sheet of paper.
Please include your name and use additional paper as necessary.
Guidance Counselor Information
In a class of_________, this student ranks number_________. Official GPA _______
Has this student given numerous hours to public service in the community? Please
explain in detail.______________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
What is this student’s attitude toward learning and communicating with others?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
List the name of scholarships, financial assistance awards, and the amount student has
received to date._____________________________________________________
___________________________________________________________________
Make any comments about the student you feel would help the selection committee to
make a wise choice ____________________________________________________
____________________________________________________________________
____________________________________________________________________
AN OFFICIAL TRANSCRIPT MUST ACCOMPANY APPLICATION.
_______________________________________________________________________
Counselor’s Signature
Date
Thank you for your interest in our scholarship program. Please mail ALL applications and ALL
supporting documentation to:
Delta Sigma Theta Sorority, Inc.
Savannah Alumnae Chapter
ATTN: SCHOLARSHIP COMMITTEE CHAIR
P. O. Box 22243
Savannah, GA 31403
Applications mailed to any other address connected to the Savannah Alumnae Chapter will NOT
be considered. Thank You!
Application Package Checklist
Academic Scholarship Application
 GPA of 89 on a 100 point scale or 3.5 on a 4.00 scale
 Successfully passed all exit tests at the time of application submission
 SAT or ACT Scores
 Proof of College/University acceptance
 Demonstrated financial need
 Current academic résumé
 Letter of recommendation
 Essay (use enclosed sheet)
 Application form
 Biographical sheet
 Guidance Counselor’s form
 Official transcript of academic record
Community Service Application
 GPA of 80 on a 100 point scale or 3.50on a 4.00 scale
 Successfully passed GHSG Writing Test at the time of application submission
 SAT or ACT Scores
 Proof of College/University acceptance
 Demonstrated financial need
 Current academic résumé
 Letter of recommendation
 Essay (use enclosed sheet)
 Application form
 Biographical sheet
 Guidance Counselor’s form
 Documented community service of 100 or greater hours—Must be on official stationery
 Official transcript of academic record
Please note that incomplete applications will be disqualified. Due: February 8, 2016.