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DELTA SIGMA THETA SORORITY, INC.,

WILLIAMSBURG ALUMNAE CHAPTER

Williamsburg, Virginia

SCHOLARSHIP AND BOOK AWARD APPLICATION FORM - 2010

Please type or print all information in ink.

I. PERSONAL INFORMATION

Name______________________________________________________________________________________

Age__________________________ Male ______________________ Female ____________________________

Address____________________________________________________________________________________

City_______________________State___________________________ZipCode___________________________

Phone Number _________________________ E-mail Address _______________________________________

Mother's Name_______________________________ Occupation_____________________________________

Father's Name__________________________________ Occupation__________________________________

Guardian’s Name _______________________________Occupation___________________________________

Number of dependents in household__________________________________________________________________________________

II. EDUCATIONAL INFORMATION

Name of High School_________________________________________________________________________

G.P.A.______________________________________________________________________________________

School Address _____________________________________________________________________________

Honors and Awards Received___________________________________________________________________________________

___________________________________________________________________________________________

College/University Attending (or planning to attend)

___________________________________________________________________________________________

___________________________________________________________________________________________

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III. ACTIVITIES (Please list any positions/offices that you have held)

School Organizations _____________________________________________________________________________________________

_____________________________________________________________________________________________

Church/Community Affiliations _____________________________________________________________________________________________

_____________________________________________________________________________________________

Hobbies/Recreational Activities _____________________________________________________________________________________________

_____________________________________________________________________________________________

Which of your activities listed above has been the most rewarding and why.

_____________________________________________________________________________________________

IV. FINANCIAL INFORMATION

Please list the type(s) of financial aid you will be receiving, the amount (s) and whether the amounts are one-time awards or ongoing:

Financial aid Expected_____________________________________________________________________________________

Parental Contribution__________________________________________________________________________________

College/University Contribution__________________________________________________________________________________

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Other Contributions

1. Name of organization__________________________________________________________________________

Amount $ ____________________________________________________________________________

2. Name of organization__________________________________________________________________________

Amount $____________________________________________________________________________

V. PLEASE PROVIDE THE FOLLOWING INFORMATION.

Student’s statement: Describe your career goals in a one page narrative.

VI. CERTIFICATION

In submitting this application, I certify that the information is complete and accurate to the best of my knowledge. Also, I understand all aspects of this application, including eligibility requirements and award amounts. Falsification of information will result in termination of any scholarship/award granted. This application becomes the sole property of Williamsburg Alumnae Chapter of Delta Sigma Theta Sorority Incorporated.

Signature of Applicant _________________________________________________________ Date________________

Signature of Parent/Guardian ____________________________________________________ Date_______________

Signature of Guidance Counselor _______________________________________________ Date_________________

Revised 1/10

Duplication Authorized