DELTA SIGMA THETA SORORITY, INC.
Waukegan Alumnae Chapter
P.O. Box 972 | Waukegan, IL 60079
Phone: (847) 604-3878 | E-mail: dstwaukeganalumnae@yahoo.com
`
ANNUAL 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. To that end, the
Waukegan Alumnae Chapter serves Lake County, Illinois and honors students who are committed to academic
excellence, positive leadership and community service by awarding scholarships to those who meet the following
eligibility criterion.
ELIGIBILITY CRITERION:
1. Is a male or female high school senior
2. Resides in and attends high school in Lake County, Illinois
3. Possesses a minimum cumulative G.P.A. of 2.5 on a scale of a 4.0
4. Demonstrates leadership ability by verifiable participation in extracurricular activities, community
organization and/or employment
5. Plans to attend an accredited technical institute/college/university on a full-time basis
A complete application packet will include the following:
1. A completed scholarship application
2. A sealed official high school transcript
3. Three (3) sealed reference letters on official letterhead of the school, organization or employer. Letter
must be typed, signed by the author and include a phone number for the author to be reached if
needed.
4. One (1) typed essay on the topic given in the Essay Topic and Guidelines section of the application
5. All required signatures
COMPLETED APPLICATIONS MUST BE POSTMARKED BY
MARCH 31 OF EACH YEAR
EVALUATION/AWARD PROCESS:
 Incomplete applications will not be considered*
 All applicants will be notified of the committee’s decision in writing in Mid-April of the current year
 Scholarship awards will be paid in the name of the recipient upon receipt of full-time enrollment from
Accredited College/University Registrar
 Scholarship award must be used within 90 days of receipt of pay out or will be forfeited/cancelled
*Applications submitted on a form that has not been approved by Delta Sigma Theta Sorority Inc. Waukegan
Alumnae chapter with ‘current as of date’ at bottom will not be considered.
PLEASE DIRECT ALL QUESTIONS/CONCERNS
REGARDING THIS APPLICATION AND/OR THE APPLICATION PROCESS
TO THE SCHOLARSHIP COMMITTEE
PHONE: (847) 604-3878 - OR - E-MAIL: dstwaukeganalumnae@yahoo.com
Page 1 of 5
SCHOLARSHIP APPLICATION
Current as of 12/2014
DELTA SIGMA THETA SORORITY, INC.
Waukegan Alumnae Chapter
P.O. Box 972 | Waukegan, IL 60079
Phone: (847) 604-3878 | E-mail:
dstwaukeganalumnae@yahoo.com
`
ANNUAL SCHOLARSHIP APPLICATION
PLEASE TYPE OR PRINT LEGIBLY USING BLACK INK
Applicant Information
Applicant Name:
Address:
City:
State:
Phone (Home): (
Zip:
)
Phone (Mobile): (
)
Email:
Age:
Birth Date:
Gender:
School Information
Female
Male
High School:
Address:
Counselor’s Name:
Overall GPA:
out of
4.0
Graduation Date:
Family Information
No. of Units/Credits:
Parent/Guardian Name:
Address:
City:
Phone (Day): (
Email:
State:
Zip:
)
Phone (Evening): (
)
Employer:
LIST ALL SIBLINGS LIVING IN THE SAME HOUSEHOLD WITH YOU
Name:
Age:
School:
Name:
Age:
School:
Name:
Age:
School:
Name:
Age:
School:
Name:
Age:
School:
Activities Information
List your extracurricular school and community activities during grades 9-12. If additional space is
required, attach one (1) 8½ x 11 sheet.
Community/Public Service Activities
Level of Participation
Dates
Organization
(i.e. office held, honors, volunteer)
MM/YY - MM/YY
-
Page 2 of 5
SCHOLARSHIP APPLICATION
Current as of 12/2014
DELTA SIGMA THETA SORORITY, INC.
Waukegan Alumnae Chapter
P.O. Box 972 | Waukegan, IL 60079
Phone: (847) 604-3878 | E-mail:
dstwaukeganalumnae@yahoo.com
`
ANNUAL SCHOLARSHIP APPLICATION
Extracurricular Activities
Dates
Organization
MM/YY - MM/YY
Level of Participation
(i.e. office held, honors, volunteer)
Awards/Recognitions
Organization
Date
MM/YY
Award
Work Experience Information
Please provide your work experience for the past three (3) years
Employer 1:
Job Title:
Duties:
Dates Employed (MM/YY – MM/YY):
Employer 2:
Job Title:
Duties:
Dates Employed (MM/YY – MM/YY):
Employer 3:
Job Title:
Duties:
Dates Employed (MM/YY – MM/YY):
References Information
Provide three (3) sealed reference letters with one (1) coming from each category below:
Name of School Administrator
Or School Counselor:
Name of Teacher
Page 3 of 5
SCHOLARSHIP APPLICATION
Current as of 12/2014
DELTA SIGMA THETA SORORITY, INC.
Waukegan Alumnae Chapter
P.O. Box 972 | Waukegan, IL 60079
Phone: (847) 604-3878 | E-mail:
dstwaukeganalumnae@yahoo.com
`
Past or Current:
Name of Community Leader
Or Employer:
ANNUAL SCHOLARSHIP APPLICATION
Education Plan Information
Desired Major:
Name of College/University
you plan to attend:
Location of College/University
(City, State):
Essay Topic and Guidelines Information
ESSAY TOPIC: Identify two (2) characteristics you possess that have helped you or are helping you
succeed/excel during your high school years AND explain how using specific examples.
The essay must be no more than 500 words, typed in 12 point font, double-spaced with normal
margins.
The word count must be listed at the end of the document.
Applicant Declaration Information
I, the applicant, declare that all of the statements in this application are true. Any false information may
disqualify me as an applicant and potential recipient of any scholarship awards to be given by Delta
Sigma Theta Sorority, Inc., Waukegan Alumnae Chapter. I agree to accept the decision of the
Scholarship Committee of Delta Sigma Theta Sorority, Inc., Waukegan Alumnae Chapter in the event
of any outcome.
Furthermore, if a scholarship is awarded to me, I give permission for my name, school information,
quotations and/or photograph to be used by Delta Sigma Theta Sorority, Inc., Waukegan Alumnae
Chapter in print or online for the sole purpose of promoting its scholarship program in the infinite future.
Applicant Signature: __________________________________________
Date: ______________
Print Name: _________________________________________________
IF APPLICANT IS UNDER AGE 18:
Parent/Guardian Signature: _____________________________________
Date: ______________
Print Name: __________________________________________________
Application Submission Information
Page 4 of 5
SCHOLARSHIP APPLICATION
Current as of 12/2014
DELTA SIGMA THETA SORORITY, INC.
Waukegan Alumnae Chapter
P.O. Box 972 | Waukegan, IL 60079
Phone: (847) 604-3878 | E-mail:
dstwaukeganalumnae@yahoo.com
`
APPLICATIONS MUST BE POSTMARKED BY MARCH 31 OF EACH YEAR.
MAIL TO:
Delta Sigma Theta Sorority, Inc.
Waukegan Alumnae Chapter
ATTN: Scholarship Committee
P.O. 972
Waukegan, IL 60079
Direct all questions/concerns regarding this application and/or the application process to the
Scholarship Committee by phone at (847) 604-3878 or e-mail at
dstwaukeganalumnae@yahoo.com
Page 5 of 5
SCHOLARSHIP APPLICATION
Current as of 12/2014