The North Carolina Agricultural &Technical State University Alumni Association Raleigh-Wake Alumni Chapter Nathaniel Hines Scholarship Application

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1 Application COMMITTED TO EDUCATIONAL EXCELLENCE Revised January 2015

2 PURPOSE: THIS SCHOLARSHIP REPRESENTS THE EFFORT OF THE RALEIGH-WAKE CHAPTER TO ASSIST THE UNIVERSITY IN ATTRACTING A QUALITY STUDENT FROM WAKE COUNTY, NORTH CAROLINA. THE ALUMNI FROM WAKE COUNTY ARE CONVINCED THAT HIGH ACADEMIC ACHIEVERS ARE NEEDED ON CAMPUS TO INTERACT WITH UNDERACHIEVING STUDENTS AND TO SERVE AS ROLE MODELS FOR ALL STUDENTS MATRICULATING AT THE UNIVERSITY. THIS PROGRAM IS A MAJOR FOCUS OF THE RALEIGH WAKE CHAPTER S ALUMNI ANNUAL GIVING PROGRAM. LEVEL OF AWARDS: THE NORTH CAROLINA AGRICULTURAL & TECHNICAL STATE UNIVERSITY ALUMNI ASSOCIATION RALEIGH-WAKE ALUMNI CHAPER NATHANIEL HINES SCHOLARSHIP IS FOR $1,000 PER ACADEMIC YEAR WITH $500 FOR THE FALL SEMESTER AND $500 FOR THE SPRING SEMESTER FOR THE PURCHASE OF BOOKS. ELIGIBILITY CRITERIA: TO BE ELIGIBLE, A CANDIDATE MUST: (A): (B): (C): BE A UNITED STATES CITIZEN WHO HAS GRADUATED OR WILL GRADUATE FROM AN ACCREDITED HIGH SCHOOL IN WAKE COUNTY, NORTH CAROLINA AND HAS ATTENDED A HIGH IN WAKE COUNTY FOR THE THREE (3) YEARS PRIOR TO THE FALL SEMESTER OF THE YEAR FOR WHICH THE SELECTION IS MADE. MEET THE REQUIREMENTS FOR ADMISSION TO NC A&T STATE UNIVERSITY. YOU MUST INCLUDE EITHER YOUR ACCEPTANCE LETTER OR COPY OF LETTER OF UNIVERSITY S RECEIPT OF YOUR APPLICATION. HAVE AN ACCUMULATED GRADE POINT AVERAGE (GPA) OF 3.0 OR BETTER ON A 4.0 SCALE. MUST HAVE A COMBINED SCHOLASTIC APTITUDE TEST (SAT) VERBAL AND MATH SCORE OF 1000 OR HIGHER OR A COMPOSITE ADMISSIONS COLLEGE (ACT) COMPOSITE SCORE OF 21 OR HIGHER. (D): INCLUDE TWO RECOMMENDATIONS/EVALUATION LETTERS; ONE MUST BE FROM A NON-SCHOOL OFFICIAL. DO NOT INCLUDE RELATIVES. THESE MUST BE ENCLOSED IN SEALED ENVELOPES. (E): A TYPED ONE PAGE DOUBLE SPACECED AUTOBIOGRAPHY. PROGRAM OPERATION: THE RALEIGH WAKE CHAPTER OF THE NORTH CAROLINA AGRICULTURAL AND TECHCNICAL STATE UNIVERSITY ALUMI ASSOCIATION WILL ALLOW THE SCHOLARSHIP WINNER TOP APPLY FOR RENEWAL OF THE SCHOLARSHIP FOR THREE ADDITIONAL YEARS PROVIDED THE STUDENT HAS A 3.0 GPA AT END OF THE FRESHMAN, SOPHMORE, AND JUNIOR YEARS AT THE UNIVERSITY. METHOD OF ACTION: ALL ITEMS MUST BE COMPLETED FOR YOUR APPLICATION TO BE CONSIDERED. THE COMPLETED APPLICATION MUST BE RECEIVED IN THE ADDRESS LISTED BELOW BY FEBRUARY 28 PRIOR TO THE FALL SEMESTER ENROLLMENT. PLEASE SEND THE COMPLETED APPLICATION ALONG WITH YOUR TWO (2) LETTERS OF RECOMMENDATION AND A COPY OF YOUR HIGH SCHOOL TRANSCRIPT TO: The North Carolina Agricultural & Technical State University Alumni Association P.O. BOX RALEIGH. NORTH CAROLINA ATTN: SCHOLARSHIP COMMITTEE INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED 2

3 INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. N.C. A&T S. U. RALEIGH-WAKE CHAPTER The North Carolina Agricultural &Technical State University Alumni Association PLEASE NOTE: THIS COMPLETED FORM WITH PERTINENT PAPERS MUST BE RECEIVED AT ADDRESS LISTED ON PAGE 2 NO LATER THAN FEBUARY 28, 2015 (NOTIFICATION OF RECEIPT OF APPLICATION WILL BE ED TO APPLICANT). IMPORTANT: PLEASE TYPE WHEN COMPLETING THIS FORM. ALL ITEMS MUST BE COMPLETED. INDICATE N/A IF AN ITEM IS NOT APPLICABLE. DATE FULL NAME (LAST, FIRST, MI) BANNER STUDENT IDENTIFICATION NUMBER (IF AVAILABLE) ADDRESS PERMANENT ADDRESS PERMANENT PHONE # DATE OF BIRTH CITY STATE ZIP PLACE OF BIRTH MONTH DAY YEAR CITY STATE NAME OF HIGH SCHOOL SCHOOL PHONE NUMBER PRINCIPAL OR HEADMASTER SCHOOL MAILING ADDRESS CITY/STATE/ZIP CODE PARENTS OR GUARDIANS: FULL NAME ADDRESS CITY/STATE/ZIP FULL NAME ADDRESS CITY/STATE/ZIP NAMES & RELATIONSHIP OF RELATIVES WHO HAVE ATTENDED NC A&T STATE UNIVERSITY (Include class year): I HAVE READ THE REGULATIONS ON PAGE TWO OF THIS APPLICATON FORM AND ACCEPT THE CRITERIA FOR THE NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY ALUMNI ASSOCIATION RALEIGH-WAKE ALUMNI CHAPTER NATHANIEL HINES SCHOLARSHIP ON THE CONDITIONS STATED THEREIN, IN ADDITION, I AUTHORIZE THE RELEASE TO THE NCATSU RALEIGH-WAKE ALUMNI SCHOLARSHIP COMMITTEE ANY INFORMATION HELD OR TO BE HELD BY SECONDARY SCHOOL AND UNIVERSITY OFFICIALS, AND OTHERS, INCLUDING, BUT NOT LIMITED TO PERSONAL EVALUATIONS AND TRANSCRIPTS. I UNDERSTAND THAT APPROPRIATE INFORMATION MAY BE RELEASED WHEN AWARDING SCHOLARSHIPS. I FURTHER UNDERSTAND THAT THE PROVIDING OF FRAUDULENT INFORMATION DISQUALIFIES ME AS AN APPLICANT FOR THIS SCHOLARSHIP. Name Date Signature PRINT NAME SIGNATURE DATE 3

4 TO BE COMPLETED BY AN OFFICIAL SCHOOL REPRESENTATIVE (IF A SEPARATE SHEET IS USED PLEASE INCLUDE THE INFORMATION ON THIS FORM) GPA IS BASED ON A 4.0 SCALE, AND IS CUMULATIVE THROUGH FALL SAT OR ACT SCORES: DATE(S) TAKEN VERBAL MATH TOTAL IN THE SPACE BELOW, PLEASE TYPE OR ATTACH YOUR RECOMMENDATION/EVALUATION OF THE NOMINEE S QUALIFICATION FOR THE NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY ALUMNI ASSOCIATION RALEIGH-WAKE ALUMNI CHAPTER NATHANIEL HINES SCHOLARSHIP. YOUR RECOMMENDATION IS EXTREMELY IMPORTANT IN DEVELOPING A COMPREHENSIVE EVALUATION OF THE NOMINEE, SO PLEASE GIVE SPECIFIC DETAILS YOU BELIEVE BEST DEMONSTRATE THE NOMINEE S STRENGTHS, INCLUDING ACADEMIC POTENTIAL AND LEADERSHIP ABILITY. STUDENT NAME: I CONFIRM THAT THE CUMULATIVE GPA AND SAT OR ACT SCORES SUBMITTED ARE CORRECT TO THE BEST OF MY KNOWLEDGE SIGNATURE OF SCHOOL OFFICIAL OR REPRESENTATIVE DATE OF CERTIFICATION TITLE THIS NOMINATION WILL NOT BE ACCEPTED WITHOUT AN OFFICIAL SIGNATURE PLEASE RETURN TO APPLICANT IN A SEALED ENVELOPE 4

5 RECOMMENDATION FORM TO BE COMPLETED BY A PERSON OTHER THAN SCHOOL OFFICIAL (IF A SEPARATE SHEET IS USED PLEASE INCLUDE THE INFORMATION REQUESTED ON THIS FORM) IN THE SPACE BELOW, PLEASE TYPE OR ATTACH YOUR RECOMMENDATION/EVALUATION OF THE NOMINEE S QUALIFICATION FOR THE NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY ALUMNI ASSOCIATION RALEIGH-WAKE ALUMNI CHAPTER NATHANIEL HINES SCHOLARSHIP SCHOLARS AWARD. YOUR RECOMMENDATION IS EXTREMELY IMPORTANT IN DEVELOPING A COMPREHENSIVE EVALUATION OF THE NOMINEE, SO PLEASE GIVE SPECIFIC DETAILS YOU BELIEVE BEST DEMONSTRATE THE NOMINEE S STRENGTHS, INCLUDING ACADEMIC POTENTIAL AND LEADERSHIP ABILITY. STUDENT NAME: SIGNATURE OCCUPATION ADDRESS PLEASE RETURN TO APPLICANT IN A SEALED ENVELOPE 5

6 N O T I C E BEFORE YOU SEAL THE ENVELOPE, HAVE YOU? Completed all items Copy of acceptance letter One page typed double space autobiography Included the two letters of recommendations/evaluations All required signatures completed Application Postmarked by February 28, 2015 Addressed envelope to: The North Carolina Agricultural &Technical State University Alumni Association P.O. BOX RALEIGH. NORTH CAROLINA ATTN: SCHOLARSHIP COMMITTEE * * DO NOT RETURN THIS SHEET * * 6