Texas Association of Developing Colleges (Tadc)

NATIONAL ORGANIZATION OF BLACK LAW ENFORCEMENT EXECUTIVES REGION ONE

NEWPERSONAL YORK INFORMATIONCHAPTER Type or Print SCHOLARSHIP APPLICATION Last Name First Name Middle Name

Permanent Street Address (please include city, state and zip)

Home Telephone Number E-mail address Date of Birth

Gender (√) □ Male □ Female

Parent/Guardian Last Name First Name Middle Name

ACADEMIC INFORMATION Graduation Current High School Address Year

College Advisor’s Name Telephone Number

List the College, University, or Technical/Trade Schools You Are Applying to:

EXTRACURRICULAR AND VOLUNTEER ACTIVITIES

Please list your extracurricular and volunteer activities, etc. In which grades Approximate time spent (Attach an additional sheet if necessary) 9 10 11 12 Hours/week Weeks/year

NOBLE New York Chapter, P.O. Box 23894, Brooklyn, NY, 11202-3894 www.noblenychapter.org [email protected] RECOMMENDATIONS

Names of Persons Providing Letters of Recommendation Relationship to Student

PERSONAL STATEMENT Essay should be typewritten and double-spaced.

Choose one of the topics below and write an essay of no more than 1,000 words in which you describe: 1. Your most satisfying academic, personal, or community service activity OR 2. Your goals for pursuing higher education.

ELIGIBILITY

To be considered, an applicant must be a high school senior in the graduating class of 2015 and be accepted to an accredited two or four-year college or university or technical school as an undergraduate full-time student in the 2015/2016 academic year. NOBLE New York Chapter scholarship awards are non renewable.

All of the following documents must be completed and enclosed: Scholarship Application Personal Statement At least one letter of Recommendation Official School Transcript Passport size photo of yourself

PLEASE MAIL THIS COMPLETED APPLICATION WITH REQUIRED ESSAY DOCUMENTS TO:

NOBLE New York Chapter P.O. Box 23894 Brooklyn, New York 11202-3894

Attention: Scholarship Committee

POSTMARK DEADLINE FOR COMPLETED APPLICATION IS JANUARY 30, 2015

Please let us know how you learned about this scholarship by sharing the name of the person, school, or organization that provided you with this application:______

I hereby declare and certify that all of the information included in this application is true and complete. I hereby grant permission to NOBLE to verify such information and to contact present and/or former employers, the schools I have attended, and the individuals whose names I have given as references. I understand that any false statements made herein will void this application and disqualify me.

______Signature of Applicant Date

Sponsor______Signature Print Name and Membership Number

NOBLE New York Chapter, P.O. Box 23894, Brooklyn, NY, 11202-3894 www.noblenychapter.org [email protected]