ILLINOIS LEGISLATIVE BLACK CAUCUS FOUNDATION 2016 - Undergraduate Scholarship Application

ILBC Board Members Scholarship Eligibility: JOINT CAUCUS CHAIRMAN This application is for students seeking an undergraduate degree. Applicants SEN. KIMBERLY A. LIGHTFORD should be an accepted student at an accredited institution of higher learning to SENATE BLACK CAUCUS CHAIRMAN include community colleges, private institutions and certified vocational training SEN. EMIL JONES III programs. HOUSE BLACK CAUCUS CHAIRMAN REP. ILBC Members, ILBC employees, ILBC Foundation board members, and their ILBC TREASURER immediate relatives are ineligible for the scholarship program. REP.

ILBC SECRETARY How to Apply: REP. You can email the Illinois Legislative Black Caucus Foundation Scholarship ILBC SGT. AT Selection Committee at [email protected] to request an application. ARMS/PARLIMENTARIAN REP. All applicants must: CAUCUS MEMBERS  Be an Illinois resident REP. JOHN ANTHONY  Complete the ILBCF Undergraduate Scholarship Application SEN. JAMES CLAYBORNE JR. SEN. JACQUELINE Y. COLLINS  Submit verification of college enrollment or letter of acceptance REP. MONIQUE DAVIS  Write a personal statement (500 words or less) describing interest and REP. WILL DAVIS REP. KEN DUNKIN involvement in community and public service, hobbies, talents, sports and/or REP. MARCUS EVANS school activities. The statement should address future academic and REP. MARY FLOWERS REP. LASHAWN FORD professional career plans and may highlight any personal challenge(s) REP. JEHAN GORDON-BOOTH perspective has overcome SEN. III REP. SONYA HARRIS  Submit high school transcript (if in college, current transcript) SEN. SEN. TOI HUTCHINSON  Submit two letters of recommendation from persons other than relatives REP. EDDIE JACKSON  Submit a recent photograph of himself/herself REP. THADDEUS JONES REP.  Provide proof of voter registration if 18 years of age or older REP.  Forward the application and all supporting materials to the ILBCF SEN. KWAME RAOUL st REP. AL RILEY Scholarship Selection Committee by May 1 (No Exceptions) REP. ANDRE THAPEDI SEN.  Any supporting material not submitted along with application will result in REP. ART TURNER applicant being disqualified. SEN. REP. CHRIS WELCH

Application Deadline: All applications for the scholarship must be postmarked by May 1st. Please take note that only applicants chosen to receive an award will be notified by letter.

Submit Applications to: Illinois Legislative Black Caucus Scholarship Foundation Selection Committee P.O. Box 10243, Springfield, IL 62791

ILLINOIS LEGISLATIVE BLACK CAUCUS FOUNDATION

2016 - Undergraduate Scholarship Application

Please print and complete form in detail filling in all appropriate blanks, be as specific as possible.

Current State Senator ______

Current State Representative ______

PERSONAL DATA:

Full Name ______Male___ Female___

Permanent Street Address ______

City ______State______Zip ______

Telephone Number ______Emergency Number ______

Date of Birth (Month/Day/Year) ______Place of Birth______Age ______

Email Address______

Father's Name (if applicable) ______Occupation ______

Mother's Name (if applicable) ______Occupation ______

Please tell us how you learned about the ILBC Scholarship______EDUCATION: ______Did you graduate? __Yes ___No Name of High School Address ______Fresh ___Soph ___Jr ___Sr Name of College Address ______Status? ______Vocational/Trade Address Official Classification (circle one) Pre-Apprentice Apprentice Other______

2. List the school you will attend or are attending: ______School Location (Applicant must submit proof of admission to an accredited college, university, or trade.)

3. List your area of study ______

4. Personal Statement (Separate Sheet 500 words or less) describing interest and involvement in community and public service.

CERTIFICATION: I hereby certify that all information in this application is true and accurate.

______Applicant Name (print) Date Applicant Signature Date