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Return your application to:  George Washington Carver Scholarship Fund, Inc., P.O. Box 3277, Atlanta, GA 30302, ATTN: Director of Student Awards.  General instructions and information for APPLYING
for a Scholarship from The George Washington Carver Scholarship Fund, Inc.

 OUR MISSION: To produce LEADERS rather than followers.

  QUALIFICATIONS:

  1. Leadership Ability, dependable, forty hours minimum volunteer work.
  2. Must attend an historically black college or university (HBCU).
  3. Documentation of financial need (complete financial aid/status form in application).
  4. Typed detailed statement of why you are applying for a scholarship and what formal goals you plan to accomplish.
  5. Describe in a brief, typed paragraph some experience or responsibility you have had in the community.
  6. A self-photograph must be attached with application (wallet size is sufficient).
  7. Official enrollment in an approved field, or dual major, in one of the following:
ACCOUNTING, AGRI-BUSINESS, AQUACULTURE SCIENCE, BIOLOGY, BUSINESS, CHEMISTRY, COMMUNICATION, COMPUTER SCIENCE, ECONOMICS, EDUCATION, ENGINEERING, NURSING, PHYSICS, PRE-LAW, PRE-MED, PUBLIC ADMINISTRATION.
  1. Applicant must participate in both RADIOTHONS (dates to be determined).
  2. All applicants must participate in a personal interview before receiving a scholarship. Each scholarship recipients will be contacted by phone or letter.
  3. All applicants must reapply each year.
·         Do not leave any questions on your application blank.  If a question does not apply to you write N/A.

·         Please notify the Scholarship Fund immediately of any changes in address or telephone number.

 

Deadline:  All applications must be received on or before May 30th.

 

PLEASE READ CAREFULLY BEFORE SIGNING BELOW.

A recipient’s scholarship will be canceled if the student is not enrolled in an approved field.  Any funds not used during the academic year in which they are awarded will be forfeited by the recipient.  All scholarship awards will be dispersed only after the Scholarship Fund has been notified by the recipient’s college or university that the recipient is enrolled full-time and majoring in an approved field.

 

Signature of Applicant _______________________________  Date____________

 

Signature of Parent    ________________________________Date____________

 

12/27/2005

 

George Washington Carver Scholarship Fund, Inc.

Scholarship Application

 

1.   Name ____________________________________________________________

            (Last)                                       (First)                                      (Middle)

 

  1. Present Address ___________________________________________________
(Number and Street)   (City)               (State and Zip)

 

  1. E-mail Address ____________________________________________________
 

  1. Phone  (______)________________              Cell Phone ____________________
 

  1. Permanent Address _________________________________________________
(Number and Street)   (City)               (State and Zip)

 

      6.   Date of Birth _______________        Place of Birth________________________

 

  1. Name and Address of High School ____________________________________
 

Grade Point Average__________      SAT/ACT Score___________

 

  1. Name and Address of College ________________________________________
 

  1. Date you must report to college_______________________________________
 

  1. College Classification this fall: (circle one) Freshman            Sophomore      Junior
Senior              Graduate Student       Med Student   Law Student

 

11. Employment History: (Please List full-time and part-time employment and  

       summer jobs held).  If more space is needed, insert another page and note

       question number.  Attach a resume if possible.

 

                 Employer’s Name                  Address          Phone             Job Title____

             ____________________________________________________________________

             ____________________________________________________________________

 
12.            Name of Church Membership____________________________________

 

                 Address_____________________________________________________

 

13.            References:     Please list three references that the interviewers can contact.

                

                 Name                           Address                       Phone              Occupation

 
            _________________________________________________________________

            _________________________________________________________________
          
            _________________________________________________________________

          

  PERSONAL HISTORY  

14.       Marital Status: Single__            Married__      Divorced__

 

15.       Total Number in Household___         Number of your children____

 

16.       Spouse’s Name________________   Occupation__________________________

 

            Spouse’s place of employment_________________________________________

 

17.       Father’s Name____________________         Occupation____________________

           

            Father’s Address & Phone____________________________________________

 

18.       Mother’s Name___________________         Occupation____________________

 

            Mother’s Address & Phone___________________________________________

 
19.              Educational Objective: Applicant must major in one or more of the following fields.

Accounting___     Biology___     Business___    Chemistry

 

Communications___   Economics__   Engineering__      Mathematics___

 

Nursing__  Physics___    Political Science___    Pre-Law___

 

20.             
Financial Status:  Estimate your projected financial status for the next year.

 

TOTAL RESOURCES:

a.   Parent Contribution                            $______________________

 

b.   Student Contribution                          $______________________

 

c.   Student Savings                                 $______________________

 

d.   Other Resources                                $______________________

 

Financial Aid:

e.   Loans (Total)                                     $______________________

 

f.    Scholarships                                      $______________________

 

g.   Grants                                               $______________________

 

h.   Veterans (G.I. Bill)                              $______________________

 

i.    Other                                                 $______________________

 

 

TOTAL EXPENSES:                      

a.   Tuition and fees                                  $______________________

 

b.   Books and Supplies                             $______________________

 

c.   Other Expenses                                   $______________________

 

d.   Housing (dorm or apt.)                        $______________________

 

e.   Transportation                                    $______________________

 

f.    Other                                                 $______________________