Ivy & Pearl. Foundation of Dallas. Ivy & Pearl Foundation of Dallas P. O. Box Dallas, Texas Travis T. Lewis Signature Scholarship

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Ivy & Pearl Foundation of Dallas Ivy & Pearl Foundation of Dallas P. O. Box 224487 Dallas, Texas 75222-4487 Travis T. Lewis Signature Scholarship Application Summary Instructions: 1. Read the entire application before you begin completing it. Use blank paper to compose answers so that you can transfer them onto the application form in a neat and orderly fashion. You may type or print neatly on the application form. 2. Attach/upload a photo of yourself to the application in the space provided. This photo should be conservative. By signing this application, you release the Ivy & Pearl Foundation of Dallas and Alpha Xi Omega Chapter to use your photograph and biographical information for possible articles in the media and/or website. 3. You will need to request a letter of recommendation from three adults (non-relatives) who know your academic ability, special talents and character. Two letters should be written by school officials on school letterhead, such as your counselor, principal, teacher, etc. A community leader, minister or supervisor from your employer must write the third letter. Please be sure the writer signs the letter. The letters should be addressed to Ivy & Pearl Foundation of Dallas, Travis T. Lewis Signature Scholarship Application, ATTN: Velena McRae, P.O. Box 224487, Dallas, Texas 75222-4487. 4. Provide the following with your completed application: a. An official copy of your transcript through December 31, 2016, that contains your rank in class, the number of students in your graduating class, and SAT or ACT test scores b. Three letters of recommendation: two from school personnel, and one from a civic leader, minister, or a work supervisor (non-relative) in the community c. Copy of Free Application for Federal Student Aid (FAFSA) or proof of family income 5. Your complete packet of materials must be postmarked by February 15, 2017. Applications postmarked after this date or with incomplete information will not be considered. Materials must be received as a packet and will not be accepted separately. 1

Conditions: 1. Only eligible female students from the Dallas County area who are graduating from high school with a B (3.00) or higher overall grade point average, applied for admission and plan to attend a four-year college or university should apply for this scholarship. 2. The application form must be fully completed with test scores, transcript through December?, 2016, photo, rank in class, number in graduating class, financial documentation and the three letters of recommendations, as specified in Item 3 of the instructions above are required. 3. The Scholarship Committee will screen application packets and select finalists. The Scholarship Interview Committee will notify finalists of the interview time and place. 4. The 2017 scholarship recipient will be invited to attend a Saturday morning sorority meeting of Alpha Xi Omega Chapter for the scholarship presentation. 5. The selected recipient will receive a 4-year undergraduate scholarship valued at $3,000.00 per year, payable to the college Financial Aid Office. Scholarship recipients must maintain a 3.0 cumulative grade point average for four years, and copies of her transcript must be submitted to the Scholarship Committee within two weeks following the end of each semester. 6. Provide proven acceptance and enrollment at a 4-year college or university. 7. Provide record of participation in school and civic activities and attach the community service documentation form provided in this packet. 8. The Scholarship may be forfeited if the recipient does not meet the eligibility factor below: a. Continue study at a 4-year college and/or university as a full-time student (Community colleges cannot be substituted); b. Failure to maintain a 3.0 cumulative GPA or better 9. Financial need will be considered. Deadline for submission: February 15, 2017 Amount of Scholarship: $3,000.00 per year, renewable for a total of 4 years. Contact Person: Ivy & Pearl Foundation of Dallas c/o Velena McRae, Scholarship Chairman P. O. Box 224487 Dallas, TX 75222-4487 Telephone 214-533-0956 (cellular) Email: scholarship@akaaxo.org 2

Ivy & Pearl Foundation of Dallas Ivy & Pearl Foundation of Dallas P. O. Box 224487 Dallas, Texas 75222-4487 Travis T. Lewis Signature Scholarship Application Please Attach/Upload Photo Please Print or Type Name (Last) (First) (MI) Home Address City State ZIP Email Address Social Security # (Last 4 Digits) Telephone# DOB Parent(s) name Parent(s) Email Address Parent(s) Telephone# Total number of siblings Number of siblings in College High School Name High School Address Have you contributed 100 hours of community service in the last year? ( ) Yes ( ) No (Please attach your Community Service documentation or use the form that is included in this packet.) 3

List Extra-Curricular Activities State Educational Goals: Name of College/Universities that have accepted you: 4

PERSONAL HISTORY AND STATEMENT OF FINANCIAL NEED Briefly summarize your personal information: Specifically describe your philosophy of life, career objectives, and special talents. Include a statement about your family life and explain why you need the scholarship. Please limit your response to the space below. Applicant s Signature Date Application Checklist Date Application Received by Committee Scholarship Submission Items Yes No Completed Application Photograph Three letters of Recommendation Official Transcript Enclosed (Sealed) SAT or ACT Scores Proof of Financial Need (FAFSA report) 5

Ivy & Pearl Foundation of Dallas Community Service Form Please use this form to provide a summary of your community service activities during high school. Return this form along with the scholarship application by February 15, 2017. If you need to report more than 10 community service activities, attach additional pages. Name Date Organization Name Activity Performed Coordinator Name & Phone # # of hours Coordinator Signature Total Hours 6