application form - Delta Sigma Theta Sorority, Charlotte Alumnae

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Delta Sigma Theta Sorority, Inc.
Charlotte Alumnae Chapter
P.O. Box 32231
Charlotte, NC 28232
________________________________________________________________
March 10, 2016
Dear Scholarship Coordinator:
The Charlotte Alumnae Chapter of Delta Sigma Theta Sorority, Inc. annually grants scholarships to
African-American high school senior women who will enroll in an institution of higher education.
The Dorothy Counts Scoggins/E. Virginia Shadd – “Breaking Barriers” Scholarship program
commemorates the achievements of two Delta Sigma Theta Sorority, Inc. women who contributed
greatly to the educational history of Charlotte.
We seek your assistance in providing the enclosed application packet to young ladies who meet the
criteria for the scholarship. Please feel free to share the complete application packet with potential
applicants. You may obtain an electronic application by visiting our website at www.charlottedst.org.
Enter the site and click on “About Us.” In the middle of the page, you will see a link entitled
“Scoggins/Shadd Scholarship.” Click on the link to retrieve the application instructions and the
application form. You may also e-mail scholarship@charlottedst.org to request an electronic copy of
these documents. Please include “Scoggins/Shadd Scholarship” in the subject line when requesting
an electronic application.
Scholarships will be awarded to the finalists during the Charlotte Alumnae Chapter’s May Week
program which will be held on May 6, 2012. Thank you in advance for your assistance. If you have
any questions, feel free to contact the scholarship committee by calling Karen Eady-Williams at (704)
312-0022 or by emailing scholarship@charlottedst.org.
Sincerely,
Desiree Rew
Desiree Rew
President, Charlotte Alumnae Chapter
By:
Karen Eady-Williams
Georgette Dixon
Pamela Murphy Lewis
Che’Landra Moore-Quarles
Co-Chairs, Scholarship Committee
Enclosures
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DOROTHY COUNTS SCOGGINS/E. VIRGINIA SHADD
“BREAKING BARRIERS” SCHOLARSHIP
APPLICATION INSTRUCTIONS
The Dorothy Counts Scoggins/E. Virginia Shadd “Breaking Barriers” Scholarship
provides financial assistance to deserving young African-American women who are high
school seniors and who will enroll in an institution of higher education. This scholarship
award commemorates the lives and achievements of two Delta Sigma Theta Sorority, Inc.
women who contributed greatly to the educational history of Charlotte. Dorothy Counts
Scoggins was the first African-American student to integrate Harry P. Harding High
School. And the late E. Virginia Shadd became the first female high school principal in
the Charlotte-Mecklenburg school system when she was appointed as principal of Myers
Park High School.
Scholarship Eligibility Criteria
1) Applicant must be an African-American female senior scheduled to graduate in
the spring of the current school year.
2) Applicant must be enrolled in a Mecklenburg County school.
3) Applicant must have a cumulative grade point average of at least 3.0 on a 4.0
unweighted scale.
4) Applicant must enroll as a full time student at a 4-year college or university
immediately after graduation from high school.
5) Applicant must demonstrate financial need.
6) Applicant must have leadership potential as evidenced by her school activities and
community involvement.
7) Delta Sigma Theta Sorority Charlotte Alumnae Debutantes are ineligible for this
scholarship.
Application Procedures
To be considered for a “Breaking Barriers” Scholarship, the applicant must:
1) Submit a completed application packet (typewritten preferred) with a postmark
of no later than April 20, 2012 to the address provided below. The completed
packet must include the following:
a. A completed and signed Application Form. Please type or print legibly.
b. Two letters of recommendation: one from a teacher or school official and
one from an adult, (e.g., an employer, minister – relatives cannot submit
recommendation letters). The letters of recommendation should include,
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but not be limited to, the length of time the reference has known the
applicant and in what capacity, applicant’s strengths and weaknesses, and
why the reference believes the applicant deserves the scholarship. The
letters of recommendation must be original versions, signed by the
writer and placed in a sealed envelope (photo copies, faxes and
electronic submissions are not acceptable).
c. An official high school transcript, including the applicant’s first semester
grades for her senior year, in a sealed envelope. Official transcripts are in
the original envelopes from the school and are sealed and stamped by the
institution. Do not open the envelope or the transcript is no longer an
official transcript.
d. An official reporting of SAT/ACT score. PLEASE READ BELOW
CAREFULLY.
i. If your school’s official transcript contains your SAT/ACT
score(s), an official report of your SAT/ACT score will not be
necessary. The school’s official transcript containing this
information will suffice.
ii. If your school’s official transcript does not contain your SAT/ACT
score(s), you must request an official report directly from College
Boards for SAT reporting or from American College Testing, Inc.
(ACT, Inc.) for ACT reporting. And we must receive the scores
from SAT/ACT by April 20, 2012.
Note: Be sure to provide the College Boards or American
College Testing, Inc. the following mailing address, if you will
have your official SAT/ACT scores sent directly to us:
Delta Sigma Theta Scholarship Committee
Attention: Pamela Murphy Lewis
8703 Fieldcroft Drive
Charlotte, NC 28277
e. An essay - no more than 750 words, typed, double-spaces and using a 12
point font. The essay should answer one of the following two questions:
1. It has been said, “Not everything that is learned is
contained in books.” Compare knowledge gained from
experience with knowledge gained from books. In your
opinion, which source is more important? Why?
2. “When people succeed, it is because of hard work. Luck
has nothing to do with success.” Do you agree or disagree
with this quotation? Use specific reasons and examples to
explain your position.
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f. A completed and signed Application Checklist. Incomplete packets will
not be considered for an award.
2) Mail the completed application packet to the following address:
Delta Sigma Theta Sorority, Inc.
Charlotte Alumnae Chapter
Scholarship Committee
8703 Fieldcroft Drive
Charlotte, NC 28277
The completed application packet must be postmarked on or before April 20,
2012.
To obtain a soft copy of the application, please visit www.charlottedst.org and click
on “Shadd/Scoggins Scholarship” or email scholarship@charlottedst.org . You may
complete the application electronically, but you must print the application and mail it.
Do not attempt to submit the application electronically; it will not be accepted
electronically.
3) Attend a personal interview with the Scholarship Committee of Delta Sigma
Theta Sorority, Inc., Charlotte Alumnae Chapter, if chosen as a finalist.
If you have questions regarding the above-stated application procedures,
please contact Karen Eady-Williams
at karen.eadywilliams@gmail.com or at 704-312-0022.
Interview
Personal interviews will be required of all scholarship finalists. Finalists will be
notified of their selection during the week of April 23rd to schedule an interview
appointment. Interviews of finalists will also be conducted during the week of April
23rd, 2012.
Scholarship Awards
1) Scholarships are a one-time award and will be disbursed only after the applicant
submits proof of enrollment at a four-year institution.
2) Each individual scholarship award will be given in an amount of not less than
$1,000.
3) All scholarships will be awarded during the May Week Program, which will be
held on May 6, 2012. All award recipients must be available to attend the May Week
awards ceremony.
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DOROTHY COUNTS SCOGGINS/E. VIRGINIA SHADD
“BREAKING BARRIERS” SCHOLARSHIP APPLICATION
(Please Complete This Form Online and Print for Mailing)
Applicant Information:
Applicant Name:
Age:
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Address:
Date of Birth: Click here to enter text.
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Email address:
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Home Telephone No.:
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Cellular Telephone No.:
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Family Information:
Parent(s)/Guardian(s) Name(s):
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List all other family members who are currently dependents or financially supported by
your parent(s)/guardian(s): (A dependent is someone who depends on your
parent/guardian as a primary source of income.)
Name: Click here to enter text.
Age:
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Name: Click here to enter text.
Age:
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Name: Click here to enter text.
Age:
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Academic Information:
High School: Click here to enter text.
Class Rank (as of 1st semester 12th grade): Click here to enter text.
Cumulative Unweighted GPA on 4.0 scale: Click here to enter text.
College Preference:
(1): Click here to enter text.
(2): Click here to enter text.
(3): Click here to enter text.
Anticipated Major or Field of Study: Click here to enter text.
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Extracurricular Activities:
Current and Past School Activities and Honors
ACTIVITY/HONOR
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DATE
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Current and Past Community Involvement and Honors
ACTIVITY/HONOR
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DATE
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Financial Information
Please provide the following information; failure to complete may disqualify your
application:
Anticipated College Expenses
Tuition/Fees:
$ Click here to enter text.
Room/Board:
$ Click here to enter text.
Books/Supplies:
$ Click here to enter text.
Other:
$ Click here to enter text.
Total Expenses:
$ Click here to enter text.
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Anticipated Annual College Income
Parent/Guardian Contribution toward
College Expenses
$ Click here to enter text.
Applicant’s savings or earnings for
$ Click here to enter text.
Anticipated and/or Received Financial Aid $ Click here to enter text.
Anticipated/Known Grants
$ Click here to enter text.
Anticipated/Known Scholarships
$ Click here to enter text.
Loans
$ Click here to enter text.
Work Study
$ Click here to enter text.
Other
$ Click here to enter text.
Any other income for college expense
(Specify : Click here to enter text.)
$ Click here to enter text.
Total Anticipated Income:
$ Click here to enter text.
Identify salary range for each of your parent(s)/guardian(s) in the columns below:
Mother
Salary Range
Father
Guardian
less than $20, 000
less than $20, 000
less than $20, 000
$20,000-$29,999
$20,000-$29,999
$20,000-$29,999
$30,000-$39,999
$30,000-$39,999
$30,000-$39,999
$40,000-$49,999
$40,000-$49,999
40,000-$49,999
$50,000-$59,999
$50,000-$59,999
$50,000-$59,999
$60,000 or more
$60,000 or more
$60,000 or more
Applicant’s Employment Information—List your employment history, beginning with
your current or most recent job. Please include the dates of your employment.
Employer
Click here to enter text.
Job Title
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Dates of Employment
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text.
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text.
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text.
DOROTHY COUNTS SCOGGINS/E. VIRGINIA SHADD
“BREAKING BARRIERS” SCHOLARSHIP CHECKLIST
Before sealing and mailing your packet, print your completed application
and place a check mark next to the numbered item below
to indicate that you have reviewed your packet
and that these items are included or have been ordered.
Please return this page with your completed application.
1.
Signed and dated Scholarship Application Form
________________
2.
Two original, sealed letters of recommendation
________________
3.
An official high school transcript with SAT/ACT score
________________
4(a).
An official high school transcript without SAT/ACT score ________________
4(b).
An official SAT/ACT report was ordered, but not received ________________
You must include the date on which you requested the official report from
College Boards, Inc. or ACT, Inc. Once the official SAT/ACT score is received,
this portion of the criteria will be satisfied.
6.
Date on which official SAT/ACT report was ordered:
________________
750-words or less typed essay included
________________
The information provided in my application packet is, to the best of my knowledge,
complete and accurate. I understand that false statements in this application may
disqualify me from consideration of this scholarship award. I also understand and agree
that all information submitted will become property of the Charlotte Alumnae Chapter of
Delta Sigma Theta Sorority, Incorporated and will be kept confidential.
Applicant’s Signature:
_______________________________________________
Date:
_________________
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