Iota Alpha Sigma Chapter’s Booker Clark Book Scholarship Application

Personal Information Form

Name: First Middle Initial Last

Address: Street Apt. #

City State Zip Code

Telephone Number

Parent(s) or Legal Guardians Name: Father Mother

Academic Information

High School: Name Address

School Counselor Phone Number

G.P.A. Favorite Subject School Organizations:

Extracurricular Activities

List and describe any extracurricular activities that you have been involved in for the last year. Be sure to detail your part in each of these organizations, included leadership positions that you held. Examples are community service events, cultural organizations, religious groups, etc.

Personal References

Please provide at least two personal references that can attest to your personal character. This can include members of either Phi Beta Sigma Fraternity, Inc. or Zeta Phi Beta Sorority, Inc., school counselors, employers, teachers, mentors, etc. (Family members may not be used.)

Name How Do They Know You Years Telephone # Known 1) 2) 3) 4)

Applicant’s Statement and Release – Please read each of the following paragraphs carefully and indicate your acknowledgement and acceptance by signing in the space provided below:

1) I am a junior or senior in high school with at least a 2.6 GPA who plans on attending either a 2 year or 4 year institution of higher education.

2) I understand that my application will be reviewed and compared with other applications for the Iota Alpha Sigma Chapter Book Scholarship.

3) I hereby give the Iota Alpha Sigma Chapter of Phi Beta Sigma Fraternity, Inc. the right to check all background information to confirm my eligibility said scholarship.

Applicant’s Signature Date

Signature of Parent or Guardian Date

Mail application packet to:

Phi Beta Sigma Fraternity, Inc. Iota Alpha Sigma Chapter 3127 Andora Drive San Jose, CA 95148

Culture for Service, and Service to Humanity

Dear Applicant:

The Iota Alpha Sigma Chapter’s Book Scholarship is opened to African-American students. The applicant must be a graduating high school Senior with a G. P. A. of 2.6 or higher.

Thank you for taking the time to apply for Iota Alpha Sigma Chapter’s annual book scholarship. The successful candidate must be present at the Pan Hellenic Council reception on Sunday June 2, 2019, in Oakland, CA. Directions to the event will be given to scholarship winner.

It is important that you read the instructions listed below, before completing this application. Candidates who fail to follow the instructions will be disqualified.

1. You must write a three to five hundred word essay on one of the following topics: A. I am the most qualified person for this scholarship because: B. My future goals and plans are: C. The most influential person in my life is and he/she has helped me in life by: D. Diversity is important to me because: 2. You must provide the screening committee with one letter of recommendation from someone who can attest to your character. (Letter may come from personal references listed on the application) 3. An official hard copy of your high school transcript must accompany your application. Fax copy not acceptable. 4. Application form with all supporting documents must be received on or before Friday May 10, 2019. 5. Mail application packet to Mr.William Bronson, Iota Alpha Sigma Chapter, 3127 Andora Drive, San Jose, CA 95148 6. Applicants must complete all portions on this application in order to be considered. 7. A recent photo should also be included.

Yours truly,

William Bronson Scholarship Chairman Cedrick Soso President, Iota Alpha Sigma Chapter