Danita L. Dickens Memorial Scholarship Application Form

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Please complete the form below and submit the following items:

1. An official high school transcript
2. Two letters of recommendation (one from a teacher and one from a counselor, community leader, or employer)
3. Copies of awards, certificates received for Academic Honors, Extra-Curricular Activities/Clubs, Service Learning /Community Outreach (Freshman – Senior years)
4. Copy of class schedule/bill from your accredited university/college
5. Required essay - provided below

DOCUMENT SUBMISSION:
All required documents MUST BE RECEIVED by Sunday, June 30, 2019. They can be emailed to moedanitaldickensscholarship@gmail.com or submitted at the Concierge Desk (envelope addressed to Bro. Aaron Williams/DLD Scholarship)

LETTERS OF RECOMMENDATION:
Please note Letters of Recommendation can be emailed to moedanitaldickensscholarship@gmail.com by the individual completing the recommendation. Recommendation emails WILL NOT BE ACCEPTED FROM THE APPLICANT DIRECTLY Subject of email should say: DLD Scholarship Recommendation for (Applicant's Name).

Email *

Applicant’s Full Name *

Sex *

Male

Female

Required

Date of Birth *

YYYY

Address *

City *

State *

Zip Code *

Phone *

Best number to contact the applicant.

Parent/Guardian Name(s) *

Parent/Guardian Contact Number(s) *

Name of High School Attended *

Date of Graduation *

YYYY

Name of University/College you will be attending this school year: (August – May) *

Expected Date of College Graduation *

Will you be a full-time student? *

YES

Required

I certify that all statements made in this application are true, complete and correct to the best of my knowledge and belief, and are made in good faith. *

Selecting YES to this question means the above statement is true.

YES, I agree to the above statement

NO, I do not agree with the above statement

Required

Please enter today's date. *

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