Jackson State University Development Foundation, Inc.

Book Award/Scholarship Application
(State the name of the scholarship for which you are applying.)
After reviewing the eligibility criteria for the book award/scholarship you are interesting in applying, complete and submit the application. The early deadline for submitting applications is February 15th and the final deadline is March 15th. Applications will not be accepted after the deadline. Incomplete applications will not be considered. All information submitted will be kept strictly confidential. JSU employees are not eligible to apply for book awards or scholarships.
If applying for the General Motors/EEOC or McCarty Farms Scholarships, check the relationship listed below:
Employee Child of Employee Spouse of Employee No Relationship
Full Name: First MI Last J#:
Name of Parent/Guardian:
Home Address:
Street City County State Zip
Home Phone: Work Phone: Cell Phone:
Local Address:
Street City County State Zip
Local Telephone: E-Mail: Sex: Female Male
U.S. Citizen: Yes No      U.S. Veteran: Yes No      Branch:
Marital Status:      Dependants: Yes No      Number
Ethnic Background: African American Caucasian Hispanic American Indian Other
Classification: Undergraduate Graduate
Status: Entering Freshman Transfer Student Currently enrolled at JSU: FR SOPH JR SR
Semester: First Semester Second Semester
GPA: Major: ACT Score: SAT Score:
Do you plan to work while in school? Yes No      Specify the number of hours per week:
If entering freshman or transfer student, please list:
Name of last school attended Telephone
Street City State Zip
High School/Community College Graduate Date:
List clubs, student and civic organizations, community and volunteer work (list offices held and give dates):

If an essay is required for a scholarship enter the required essay in this section. (max 1500 char.)
Remaining characters:
If additional donor-required information is requested for a scholarship, enter the required information in this section.
Be certain that all requested information is included and the requested documents are attached before submitting the application. Incomplete applications will not be considered.
By entering my name in this box, I certify that all information in this application, to the best of my knowledge, is true and accurate.

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