<p> NATIONAL ORGANIZATION OF BLACK LAW ENFORCEMENT EXECUTIVES REGION ONE</p><p>NEWPERSONAL YORK INFORMATIONCHAPTER Type or Print SCHOLARSHIP APPLICATION Last Name First Name Middle Name</p><p>Permanent Street Address (please include city, state and zip)</p><p>Home Telephone Number E-mail address Date of Birth</p><p>Gender (√) □ Male □ Female</p><p>Parent/Guardian Last Name First Name Middle Name</p><p>ACADEMIC INFORMATION Graduation Current High School Address Year</p><p>College Advisor’s Name Telephone Number</p><p>List the College, University, or Technical/Trade Schools You Are Applying to:</p><p>EXTRACURRICULAR AND VOLUNTEER ACTIVITIES</p><p>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</p><p>NOBLE New York Chapter, P.O. Box 23894, Brooklyn, NY, 11202-3894 www.noblenychapter.org [email protected] RECOMMENDATIONS</p><p>Names of Persons Providing Letters of Recommendation Relationship to Student</p><p>PERSONAL STATEMENT Essay should be typewritten and double-spaced. </p><p>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.</p><p>ELIGIBILITY</p><p>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. </p><p>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</p><p>PLEASE MAIL THIS COMPLETED APPLICATION WITH REQUIRED ESSAY DOCUMENTS TO:</p><p>NOBLE New York Chapter P.O. Box 23894 Brooklyn, New York 11202-3894</p><p>Attention: Scholarship Committee </p><p>POSTMARK DEADLINE FOR COMPLETED APPLICATION IS JANUARY 30, 2015</p><p>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:______</p><p>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.</p><p>______Signature of Applicant Date</p><p>Sponsor______Signature Print Name and Membership Number</p><p>NOBLE New York Chapter, P.O. Box 23894, Brooklyn, NY, 11202-3894 www.noblenychapter.org [email protected]</p>