CENTRAL MS
OLE MISS REBEL CLUB
January 27, 2015
Dear Guidance Counselor,
Each spring the Central MS Ole Miss Rebel Club (“CMOMRC”) awards scholarships to deserving
area students. These scholarships may be used for freshmen year tuition and expenses at The
University of Mississippi. Last year we awarded sixteen $1,000.00 scholarships.
We are seeking nominations for scholarship recipients for the 2015-2016 academic year at Ole
Miss. To be eligible, a student must be on track to graduate high school in 2015 with a “B”
average and must have scored between 21 and 28 (inclusive) on the ACT. Past scholarship
recipients have demonstrated leadership qualities in school, religious, and/or community
organizations.
The public announcement of the scholarship winners will be made at our annual Scholarship
Luncheon later this Spring. Recipients will be notified in advance and are EXPECTED to attend
this event with their parents or guardian(s).
Please give the attached instructions and application to any eligible high school seniors.
Student’s applications MUST be postmarked BY FRIDAY, MARCH 27, 2015 and should be sent
to the following address:
CENTRAL MS OLE MISS REBEL CLUB
SCHOLARSHIP COMMITTEE
POST OFFICE BOX 13294
JACKSON, MS 39236-3294
If you have any questions or need additional information, please feel free to call me at
601-927-8544 or email me at centralmsolemissalumniclub@gmail.com.
Sincerely,
Bob Box
President
Central MS Ole Miss Rebel Club
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CENTRAL MS
OLE MISS REBEL CLUB SCHOLARSHIP
SCHOLARSHIP OFFERED AND POSTMARK DEADLINES
The scholarship committee will review all of the candidates and will award $1,000.00
scholarship to eligible selected students. The scholarships will be paid to the University of
Mississippi, with $500.00 credited to the fall semester of 2015 and $500.00 credited to the
spring semester of 2016. To be included in the selection process, your application MUST be
postmarked no later than FRIDAY, MARCH 27, 2015.
ELIGIBILITY
Students must be attending a qualifying educational institution under Section 501(c) (3) of the
Internal Revenue Code of 1986, as amended. The educational institution must be located
within the eight counties of the CMOMRC serves (Copiah, Hinds, Leake, Madison, Rankin, Scott,
Simpson, and Yazoo). Students who board at institutions outside these eight counties but
maintain a home address within the counties are also eligible. Students must be on track to
graduate high school in 2015 with a “B” average and an ACT score between 21 and 28
(inclusive). Past scholarship recipients have demonstrated leadership qualities in school,
religious, and/or community organizations.
CRITERIA
Scholarships are awarded to eligible students based solely upon merit and without regard to
gender, race, color, or creed. All applications become the property of CMOMRC and will NOT
be returned.
HOW TO BE CONSIDERED
Complete the application form in FULL and send to:
CENTRAL MS OLE MISS REBEL CLUB
SCHOLARSHIP COMMITTEE
POST OFFICE BOX 13294
JACKSON, MS 39236-3294
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CENTRAL MS OLE MISS REBEL CLUB (CMOMRC)
2015-2016 SCHOLARSHIP APPLICATION
READ AND COMPLETE THIS APPLICATION CAREFULLY AND NEATLY
PRINT ONLY USING BLUE OR BLACK INK
ONLY COMPLETED APPLICATIONS WILL BE CONSIDERED
IF YOU NEED MORE SPACE TO GIVE ANY MORE INFORMATION, PLEASE ATTACH SEPARATE PAGES
PERSONAL DATA
NAME
PHONE
ADDRESS
EMAIL ADDRESS
CITY, STATE, ZIP
SOCIAL SECURITY NUMBER
PARENTS/GUARDIANS DATA
PARENTS/GUARDIANS NAME
PARENTS/GUARDIANS PHONE
PARENTS/GUARDIANS ADDRESS
PARENTS/GUARDIANS PHONE
PARENTS/GUARDIANSCITY, STATE, ZIP
PARENTS/GUARDIANS EMAIL ADDRESS
ACADEMIC BACKGROUND
HIGH SCHOOL
ACT SCORE
DATES ATTENDED
OVERALL GRADE POINT AVERAGE
CLASS RANK (EX:
15 OF 202 STUDENTS)
EXPECTED HIGH SCHOOL GRADUATION DATE
EXTRACURRICULAR ACTIVITIES AND HONORS
EXTRACURRICULAR ACTIVITIES AND OFFICES HELD (INCLUDE ACADEMIC, SPORTS, ETC.)
HONORS AND AWARDS RECEIVED
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CENTRAL MS OLE MISS REBEL CLUB (CMOMRC)
2015-2016 SCHOLARSHIP APPLICATION
READ AND COMPLETE THIS APPLICATION CAREFULLY AND NEATLY
PRINT ONLY USING BLUE OR BLACK INK
ONLY COMPLETED APPLICATIONS WILL BE CONSIDERED
IF YOU NEED MORE SPACE TO GIVE ANY MORE INFORMATION, PLEASE ATTACH SEPARATE PAGES
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Page 2 of 3
CENTRAL MS OLE MISS REBEL CLUB (CMOMRC)
2015-2016 SCHOLARSHIP APPLICATION
READ AND COMPLETE THIS APPLICATION CAREFULLY AND NEATLY
PRINT ONLY USING BLUE OR BLACK INK
ONLY COMPLETED APPLICATIONS WILL BE CONSIDERED
IF YOU NEED MORE SPACE TO GIVE ANY MORE INFORMATION, PLEASE ATTACH SEPARATE PAGES
EMPLOYMENT INFORMATION (IF APPLICABLE)
CURRENT EMPLOYER (BUSINESS NAME & OWNER)
ADDRESS
CITY, STATE, ZIP
TELEPHONE
JOB TITLE AND JOB DESCRIPTION/DUTIES
WORKING HOURS PER WEEK
LIST CAREER GOALS AND OBJECTIVES
REFERENCES (MUST INCLUDE AT LEAST ONE TEACHER):
NAME
NAME
TITLE
TITLE
ADDRESS
ADDRESS
CITY, STATE, ZIP
CITY, STATE, ZIP
TELEPHONE
TELEPHONE
NAME
NAME
TITLE
TITLE
ADDRESS
ADDRESS
CITY, STATE, ZIP
CITY, STATE, ZIP
TELEPHONE
TELEPHONE
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CENTRAL MS OLE MISS REBEL CLUB (CMOMRC)
2015-2016 SCHOLARSHIP APPLICATION
READ AND COMPLETE THIS APPLICATION CAREFULLY AND NEATLY
PRINT ONLY USING BLUE OR BLACK INK
ONLY COMPLETED APPLICATIONS WILL BE CONSIDERED
IF YOU NEED MORE SPACE TO GIVE ANY MORE INFORMATION, PLEASE ATTACH SEPARATE PAGES
Please also have your guidance counselor write a letter of recommendation. The guidance
counselor may mail that in separately, or you may include in in your application packet in a
SEALED ENVELOPE.
Please return original application PLUS TWO (2) COPIES
CENTRAL MS OLE MISS REBEL CLUB
SCHOLARSHIP COMMITTEE
POST OFFICE BOX 13294
JACKSON, MS 39236-3294
WITH CORRECT POSTAGE to:
CMOMRC scholarships are funded by the District 8 Ole Miss Alumni Club.
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