Chi Omicron Omega Chapter

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1 (Please Print) Alpha Kappa Alpha Sorority, Inc. Chi Omicron Omega Chapter P. O. Box 6377, Katy, TX Launching New Dimensions of Service Scholarship

2 Rules & Information Eligibility / Requirements 1. Be a student in good standing in Alief ISD, Cy-Fair ISD, Ft. Bend ISD (Stephen F. Austin H.S., George Bush H.S., William B. Travis H.S. Only) HISD (Westside H.S. Only), Katy ISD, Lamar Consolidated ISD. a. Minimum of 2.5 GPA (unweighted) b. Successfully completed ALL parts of EOC exam c. Documentation of community service hours 2. Be classified as a Senior 3. Graduate before July 1, Complete the application in its entirety, incomplete applications will be disqualified 5. Attend an accredited two or four-year college or university 6. Submit applications on or before due date, late applications will be disqualified. Scholarship Award Amounts 1. One scholarship of $1000 will be awarded. 2. The scholarship award recipient will be notified by phone and mail before June 30, Disbursement Obligations Scholarship disbursements will be paid in the fall semester of 2016 once student provides proof of enrollment (i.e. letter from school s registrar, bill from bursar s office, or class schedule is required).

3 of High School District: Alief ISD Fort Bend ISD (Bush, Austin, Travis) Katy ISD Cy Fair ISD HISD (Westside) Lamar Consolidated ISD 2016 Scholarship Application (Please print) First Middle Last Home Address Number Street City State Zip Code Telephone ( ) Race Ethnicity Father s Occupation Mother s Guardian (if Applicable) Occupation Full Address (if different from above) Phone Alt. Phone Please indicate below, by check, the annual income of your family. Less than $20,000 $20,000 to $40,000 $40,000 to $80,000 $80,000 to $100,000 $100,000 to $125,000 $125,000 and above High School Graduation Date of School Counselor Phone Number Number in your graduating class Your Class Rank Grade Point Average out of a possible ACT Score SAT Score Verbal Math Writing

4 College Preferences: Applied? Yes Not Yet Accepted? Yes Not Yet College Major Preferences: What other scholarships, grants, etc. have you applied for, received? Be specific. Employment while in High School Date (From-to) Type of Work Employer s Address & Phone Awards and Special Recognition (Honor Society, National Merit, Perfect Attendance) Year Award Honored for: High School Extracurricular Activities Publications, clubs, student government, athletics, band. If necessary, attach additional sheet for activities. Year Activity Office Held, Roles and Responsibility, etc. Community Service Activities (Scouts, Church, and Volunteering) (please attach proper documentation on letterhead) Year Activity Office Held, Roles and Responsibility, etc.

5 Additional items that MUST be included with this application: 1) Essay words about your educational, career goals, and financial need (attach separate sheet). 2) Submit two (2) letters of Recommendation (counselor, teacher, community leader ) 3) Include high school transcript (Official Sealed) Grades ) Include a copy of your SAT/ACT Report 5) A copy of your last report card *** Alpha Kappa Alpha does not discriminate based on race, creed, or religion *** Signature of Applicant Signature of Counselor Completed Applications must be postmarked by April 1, 2016 Send Completed Application to: Chi Omicron Omega 2016 Scholarship PO Box 6377 Katy, TX Application may be mailed to the address above or electronically to: akachiomicronomega@gmail.com (Electronic transcripts must be submitted directly from a school official or sealed transcripts may be mailed to above P.O. Box) Contact Person: Paulette Jones Committee Chair Paulette.jones3aka@gmail.com

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