Young , Gifted , & Black College Scholarship Application Form

Young, Gifted, & Black College Scholarship Application Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Scholarship Application Type*
Educational Information
Name of High School Attended*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence: *
Ranking in Graduation Class
Date Expected to Graduate*

MonthDayYear
Date
Academic awards and/or honors you received in High School*
Are you a member of any organization in your school? Please provide information*
Are you a member of any organization outside your school? Please provide information
Recommendations

Two (2) letters of recommendation from any of the following persons (no more than one per category) Received By: April 13, 2023.
All letters must include the contact information of the person providing the recommendation and must be signed in ink. Recommendations from family members in the categories below will not be accepted. It is suggested that you ask the people who are writing your recommendations to comment upon: (1) the length of time they have known you; (2) your personal qualities, character, leadership abilities, and/or any special attributes; and (3) why they believe you have the perseverance to succeed at the college/university

High School TeacherMinisterHigh School CounselorOrganizational SponsorHigh School PrincipalVolunteer CoordinatorCommunity LeaderEmployer
Upload here your Letter of Recommendation #1*

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Upload here your Letter of Recommendation #2*

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(Transcript) Official Documentation
Upload here your High School Transcript information*

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Essay

Essay should be 500 words or less. font size 12, Times New Roman font, 1.5 to double-spaced, one-inch margins
Tell Us Your Opinion of the #1 Reason for Violence in Schools and if given an opportunity as a youth leader, what would you do to prevent youth violence in schools and the community? You may use this space to upload your essay via PDF.
Upload Your Essay information*

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Parental Information
Name of Mother or Guardian*

First NameLast Name
Mother's Job/Position
Address of Mother

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Father

First NameLast Name
Father's Job/Position
Address of Father (if not the same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Photo Release

Parents Must Confirm The Photo Release Form With Initialing that they have read and received , and approve of The Leadership Church Using the Student's Photo.
I grant The Leadership Church and its volunteers, employees, agents, representatives, and licensees permission to copy, edit, publish and my child /student image and likeness, with or without my name, including for marketing purposes or for any other lawful purpose, in any publication and in any medium, including, by way of example and not limitation, posting a photo of me from the activity on a social media web site,(collectively, “Reproduction”) without further consideration. I assign to the church all right, title, and interest in and to all such Reproductions as well as the unencumbered right to exercise such rights in all media and by any means now known or hereafter created, throughout the world, in perpetuity.I hereby hold harmless and release and forever dischargeGlobal Leadership Christian Center-and its volunteers, employees, agents, representatives, and licensees, from all claims, demands, and causes of action which I or the undersigned or any respective heirs, executors, administrators or assigns have or may have resulting by reason of this Photo Release Form. I HAVE READ THIS PHOTO RELEASE BEFORE SIGNING BELOW AND IFULLY UNDERSTAND THE CONTENTS, MEANING, AND IMPACT OF THIS PHOTO RELEASE FORM*
Parent Initial Here Confirming The Photo Release

Student Application Certification:
I CERTIFY THAT ALL STATEMENTS OR INFORMATION I HAVE PROVIDED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY DELIBERATE MISREPRESENTATION FOUND IN THIS APPLICATION MAY BE CAUSE FOR THE APPROVAL OF THIS APPLICATION AND MAY PROHIBIT ME FROM APPLYING AGAIN IN THE FUTURE.
Applicant's Signature

Clear
Name of Applicant

First NameLast Name
Date Signed by Applicant

MonthDayYear
Date
Should be Empty:

Young, Gifted, & Black College Scholarship Application Form

Educational Information

Recommendations

(Transcript) Official Documentation

Essay

Parental Information

Photo Release

Student Application Certification: