Key Dates: Application Release- November 11, Application Due & Postmarked by - January 12, 2018

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Dr. Marlene Dominguez Hicks Memorial Scholarship The Greater Grand Rapids Chapter of Jack AND Jill Of America Incorporated Key Dates: Application Release- November 11, 2017 Application Due & Postmarked by - January 12, 2018 Recipient(s) Notification- February 9, 2018 HBCU Tour: 2018 Eastern Tour - District of Columbia, Maryland, Virginia Date April 1-8, 2018 Colleges and Universities Bowie State University Coppin State University Hampton University Howard University Morgan State University Norfolk State University

The Dr. Marlene Dominguez Hicks Memorial Scholarship Application Dr. Marlene Dominguez Hicks graduated from Stanford University with a Bachelor of Science degree in Biology and a Doctor of Medicine from Meharry Medical College in Nashville, Tennessee. Founded in 1876, Meharry Medical College is one of the nation s oldest and largest historically black academic health science centers dedicated to educating physicians, dentists, researchers and health policy experts. Dr. Hicks was a member of the Greater Grand Rapids Chapter of Jack and Jill of America, Inc. She had a heart for service and a commitment to education. Dr. Hicks utilized her talents by serving on numerous committees including the HBCU Tour Experience Scholarship Committee, Building Tomorrow s Leader HBCU College and STEAM Fair, Christmas Committee, Audit Committee and Budget Committee. She also served as Treasurer for the 2015-2016 programming year. Dr. Hicks was a devoted wife, mother and extraordinary physician. Purpose For generations, the promise of an education has been a beacon of hope for millions of Americans seeking a better life. At a time when it was deemed illegal for African Americans to learn to read or write, brave men and women took great risks to learn these skills in secret. After the Civil War, determined individuals made extraordinary sacrifices to establish the institutions we know today as Historically Black Colleges and Universities (HBCUs). These schools waged a war against illiteracy and ignorance and offered a newly free people the opportunity to write their own chapter in the American story. Greater Grand Rapids Chapter of Jack and Jill of America HBCUTE Scholarship 1

Jack and Jill of America, Incorporated is proud of its relationship with HBCUs across the country and is committed to supporting these institutions in their quest to educate our children. In support of HBCU s, the Greater Grand Rapids Chapter of Jack and Jill of America, Inc. will grant a maximum of two (2) scholarships to offset the cost of participation in the HBCU Tour Experience (HBCUTE) for two deserving award recipients. Eligibility 1. Applicant plans to attend a 4-year accredited college or university. 2. Applicant has identified an area of study (major). 3. Applicant must be a US citizen. 4. Applicant is willing and able to attend HBCUTE required Pre-Tour workshops. The Greater Grand Rapids Chapter of Jack and Jill of America Inc. HBCU College Tour Scholarship Awards are awarded without regard to race, sex, religion, age, national origin or sexual orientation. The Greater Grand Rapids Chapter of Jack and Jill of America Inc. will not award scholarships to applicants who are not qualified and reserves the right to not award a scholarship in a given year. Application Requirements To be considered for a Greater Grand Rapids Jack and Jill of America Inc. College Tour Scholarship Award, applicants must complete an application and email it to ggrjjoa@gmail.com by January 12, 2018. The application must include: 1. A completed application form (Attached). 2. A student essay not to exceed 1000 words in length. 3. One letter of recommendation from a teacher or guidance counselor; not to exceed 1-page. This recommendation should support your collegiate ambitions and moral character. Essay Instructions Please write a clear, concise essay, not to exceed 1,000 words in length. Greater Grand Rapids Chapter of Jack and Jill of America HBCUTE Scholarship 2

What is the importance of getting an education at either a Historical Black or Historical white colleges/universities which will contribute to the legacy you want to leave for future generations? Selection Criteria 1. Completion of all eligibility criteria. 2. Clearly demonstrated interest in pursuing higher education. 3. Well-written AND grammatically correct essay. 4. For High School Senior applicants only: must apply to a HBCU and provide proof of application. Awards A maximum of two one-time HBCUTE scholarships limited to covering the cost of tour participation and meals only will be granted. All college tour scholarship awards will be paid directly to the college tour vendor affiliated with the Greater Grand Rapids Chapter of Jack and Jill of America Inc. Award recipients are required to attend preliminary mentoring sessions and workshops offered before the actual tour. Documentation supporting attendance at the sessions and workshops is due before payment is rendered to the vendor. Such documentation must come from the local HBCUTE organization. After the HBCU tour experience is completed, scholarship winners are required to submit A Reflective Essay including pictures to the Greater Grand Rapids Chapter of Jack and Jill of America Inc. by no later than Monday, April 23, 2018. Greater Grand Rapids Chapter of Jack and Jill of America HBCUTE Scholarship 3

APPLICATION The Greater Grand Rapids Chapter of Jack and Jill of America Inc. College Tour Scholarship Award Application Reminder: Submit Student Essay with application. **Please Print** Name Address Email Name of High School Grade Level: Freshman Sophomore Junior Senior GPA/ACT/SAT: Name three colleges/universities you are interested in attending? Have you applied to any colleges/universities if you are a Senior? If so, please list them. Greater Grand Rapids Chapter of Jack and Jill of America HBCUTE Scholarship 4

Name three college majors you are interested in? Provide a list of your community service and/or extracurricular activities? By signing this form, I commit to attending all meetings/mentoring sessions, tour experience and adhering to all rules and policies associated with the HBCUTE. Signature Phone Number Date By signing this form, I grant my child permission to apply for the one-time scholarship offered by the Greater Grand Rapids Chapter of Jack and Jill of America, Inc. I also grant my child permission to attend all meetings/mentoring sessions, tour experience and adhere to all rules and policies associated with the HBCUTE. I understand that non-compliance could result in award revocation. Parent/Guardian Name (print) Address E-mail Parent/Guardian Phone Number Parent Signature Date Greater Grand Rapids Chapter of Jack and Jill of America HBCUTE Scholarship 5