Please remember that application guidelines must be strictly followed. All applicants must be recommended by a sponsoring Assembly.
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1 To: From: Ref: State Grand Loyal Lady Ruler Wanda Davis State Coordinator of Organizers and Overseers Pattie Brown (PSGLLR) State Grand Organizers and Overseers Loyal Lady Rulers and Assembly Officers Loyal Ladies of the Orient ofnorth Carolina State Grand Scholarship Committee Loyal Lady Kay T. Thomas #57, Chair State Grand Scholarship Program Date: August 25, 2016 The Annie P. Rogers State Grand Assembly Scholarship Committee will accept applications for the academic year. A $1,000 scholarship will be awarded to a deserving female or male student from each Area. Application guidelines are attached and must be strictly adhered to. The applications may be copied for any female or male student desiring to be considered for a scholarship. We are requesting applications from all four Areas. The committee is requesting that each sponsoring Assembly review the applications for completeness before submitting them to the Scholarship Committee. Sponsoring Assemblies should forward a copy of the application to their Organizer and Overseer for information. In order to be considered, applications must be in the hands of the Chairperson by March 5, Please remember that application guidelines must be strictly followed. All applicants must be recommended by a sponsoring Assembly. A letter of verification from the accepting school with enrollment dates must be submitted to the Committee Chairperson by September 20, This will be forwarded to the State Grand Assembly for issuance of the check. Please address questions to Loyal Lady Kay T. Thomas at Mail all applications and correspondence to: LL Kay T. Thomas 1837 Augustus Drive Rocky Mount, NC 27801
2 THE ANNIE P. ROGERS STATE GRAND ASSEMBLY ORDER OF THE GOLDEN CIRCLE, AASR, PHA SCHOLARSHIP APPLICATION DEADLINE DATE: MARCH 5, 2017
3 SCHOLARHSHIP GUIDELINES FOR APPLICATION COMPLETION 1. The student is recommended and sponsored by an Assembly. 2. The student must be entering college for the first time. 3. The application should be typed or printed on all three pages. The family information sheet must be completed. 4. A small photograph should be attached. The photograph will not be returned. 5. A copy of your high school transcript should be attached. 6. An average grade of "C" or better; with a 2.5 grade point average or better. 7. Financial needs should be identified. 8. Two letters of recommendation (i.e. Minister, Instructor, Guidance Counselor, and/or Civic Leader) should come with the application. 9. THE APPLICATION MUST BEAR THE SEAL OF THE SPONSORING ASSEMBLY AND THE SIGNATURE OF THE LOYAL LADY RULER, LOYAL LADY SECRETARY AND THE SCHOLARSHIP CHAIR. 10. Proof of enrollment from an accepting college or university of applicant's choice must be received by September 30, 2017, in order for the check to be issued by the State Grand Assembly.
4 THE ANNIE P. ROGERS STATE GRAND ASSEMBLY ORDER OF THE GOLDEN CIRCLE, AASR, PHA DEADLINE MARCH 5, 2017 STUDENT INFORMATION Photo Full Name: First Middle Last Home Address: Street City State Zip Birth Date: / / _ Telephone: { _} - High School: Name Address Date of Graduation: GPA: Class Rank: Counselor: Religion: Organizations: {Student affiliations, including clubs, volunteer, civic and community activities:} Academic Awards or Honors: Talents, skills, and hobbies: Are you a registered voter: _ Have you ever committed a felony: _ If so, please explain:
5 FAMILY INFORMATION Mother s Full Name Home Address if different from yours: _ Occupation: Title/Position Name of Business/Organization Name of College {if any} Degree Year Father s Full Name Home Address if different than yours: _ Occupation: Title/Position Name of Business/Organization Name of College {if any} Degree Year If not with both parents, with whom do you live: Health: Excellent Average _ Fair Poor Give a brief statement as to why you need a scholarship: List four references other than family members: Name Address Telephone Numbers Date: _ Signature of Applicant
6 ACADEMIC INFORMATION List in order of preference the colleges, universities, or other institutions of higher learning you are interested in attending and/or have formally applied for admissions. Please check those you have already applied to: Name of Institution Address Applied Desired College majors: Career Objective: Are you a recipient of other scholarships? If so, please list Additional Information: {Include any data you feel would be useful for scholarship consideration.} Recommended and Submitted by: Assembly Name/Number & Region Loyal Lady Ruler Signature Phone # Loyal Lady Scholarship Chair Phone # Loyal Lady Secretary Phone # _ SEAL
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