Tau Omicron Chapter. Omega Psi Phi Fraternity, Inc.

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Tau Omicron Chapter Of Omega Psi Phi Fraternity, Inc. P.O. Box 3249 Martinsville, Virginia 24112 February 26, 2016 Dear Senior Counselor, The Tau Omicron Chapter of the Omega Psi Phi Fraternity, Inc. will award a scholarship to a 2016 graduating senior student in the amount of $500.00 for the 2015-16 school year to help defray educational cost at an institution of higher education. Requirements for this scholarship are mainly an academic average of not less than 2.5 on the four point grading scale and the student must demonstrate a need for scholarship and exemplify high moral character. If you have students who meet these criteria (see attachment) and who are interested in making application for this scholarship, please have them complete the application and return it postmarked by May 2, 2016 to the above address. Notification of the scholarship recipient will be forwarded by or before May 20, 2016. If you have any questions, please contact me at 276-632-7128. We look forward to responses from your students. Sincerely, Greg Preston Omega Psi Phi Fraternity Scholarship Committee

Tau Omicon Chapter Of Omega Psi Phi Fraternity, Inc. PO Box 3249 Martinsville, VA 24112 OMEGA PSI PHI SCHOLARSHIP CRITERIA In order for one to be awarded the scholarship, one must meet the following scholarship, need, and moral character criteria. SCHOLARSHIP: An eligible student for the scholarship must have a grade point average of not less than 2.5 on the four point grading scale. NEED: The financial circumstances of the applicant shall be such that scholarship aid is necessary to continue formal education. MORAL CHARACTER: The applicant must be strong in traits which exemplify high moral character as determined by the school administration or the guidance counselors.

OMEGA TAU OMICRON CHAPTER Class Rank C.B.S. (I-E) G.P.A. (I-E) Other Funds (II-K/L) Salaries (II-A/B) Contributions (II-I) College Cost (II-I) Thoroughness COMPLETE THIS FORM AND RETURN IT TO YOUR HIGH SCHOOL GUIDANCE COUNSELOR. ALL QUESTIONS MUST BE ANSWERED IN ORDER FOR YOU TO BE CONSIDERED FOR THE OMEGA PSI PHI FRATERNITY S SCHOLARSHIP. ALL INFORMATION WILL BE CONSIDERED CONFIDENTIAL, AND IT WILL NOT BE GIVEN TO ANYONE UNDER ANY CIRCUMSTANCE. SECTION I TO BE COMPLETED BY THE APPLICANT PART A A. NAME OF APPLICANT Last First Middle B. HOME ADDRESS Street or Box City State Zip C. PLACE OF BIRTH _ City State D. DATE OF BIRTH PRESENT AGE Month Day Year E. HIGH SCHOOL CURRENTLY ATTENDING EXPECTED GRADUATION DATE Month Year COLLEGE BOARD SCORES: Verbal Math _ GRADE POINT AVERAGE Senior Year IMPORTANT: ATTACH AN OFFICIAL TRANSCRIPT OF ALL HIGH SCHOOL WORK COMPLETED TO THIS APPLICATION. COLLEGE PLANNING TO ATTEND ADDRESS Street or Box City State Zip F. HONORS AND AWARDS RECEIVED

G. EXTRA-CURRICULAR ACTIVITIES H. WHAT SUMMER JOBS HAVE YOU HELD? I. WHAT PART-TIME JOBS HAVE YOU HAD? J. DO YOU PLAN TO HAVE A PART-TIME JOB WHILE ATTENDING COLLEGE? Yes No K. ARE YOU APPLYING OR HAVE YOU RECEIVED OTHER SCHOLARSHIPS? Yes No SCHOLARSHIP DATE AMOUNT $ SCHOLARSHIP DATE AMOUNT $ SCHOLARSHIP DATE AMOUNT $ L. WHAT OTHER FINANCIAL ASSISTANCE WILL YOU RECEIVE? SOURCE AMOUNT $ SOURCE AMOUNT $ SOURCE AMOUNT $ M. DO YOU PLAN TO ATTEND COLLEGE? N. WHAT DO YOU PLAN TO STUDY IN COLLEGE?

O. EXPLAIN WHY YOU NEED FINANCIAL ASSISTANCE TO FURTHER YOUR FORMAL EDUCATION? BE THOROUGH AND INCLUDE AS MANY DETAILS AS POSSIBLE REGARDING YOUR FINANCIAL SITUATION. ATTACH AN ADDITIONAL SHEET IF NEEDED. APPLICANTS SIGNATURE DATE PART B SECTION II TO BE COMPLETED BY PARENT OR GUARDIAN. PLEASE INDICATE IF A PARENT IS DECEASED. A. FATHER S NAME AGE ADDRESS Street or Box City State ZIP OCCUPATION EMPLOYER YEARLY INCOME $ _ B. MOTHER S NAME AGE ADDRESS Street or Box City State ZIP OCCUPATION EMPLOYER YEARLY INCOME $ _

C. GUARDIAN S NAME ADDRESS Street or Box City State ZIP OCCUPATION EMPLOYER _ YEARLY INCOME $ _ D. ARE THERE OTHER SOURCES OF INCOME SUCH AS SOCIAL SECURITY, HELP FROM FAMILY MEMBERS, ARMED SERVICE PAYMENTS, ETC? PLEASE LIST AND INDICATE THE AMOUNT(S) E. NUMBER OF SISTERS AND BROTHERS OF THE APPLICANT _ NUMBER LIVING AT HOME AGES,,,,,, F. NUMBER OF FAMILY MEMBERS IN INSTITUTIONS OF HIGHER EDUCATION NAME OF COLLEGE, ETC. G. WHAT WILL BE THE TOTAL COST OF COLLEGE EXPENSES FOR ONE YEAR? $ H. HOW MUCH WILL YOU CONTRIBUTE? $ I. ARE THERE FAMILY CIRCUMSTANCES THAT THE SCHOLARSHIP COMMITTEE SHOULD KNOW ABOUT THAT WILL PRECLUDE THE FAMILY S ABILITY TO PAY THE APPLICANT S FEES? IF SO, PLEASE EXPLAIN AND ATTACH AN ADDITIONAL SHEET IF NEEDED. J. THE PARENT OR GUARDIAN AGREES TO FURNISH THE OMEGA PSI PHI FRATERNITY S SCHOLARSHIP COMMITTEE VERIFICATION OF INFORMATION LISTED ABOVE IF NEEDED. VERIFICATION OF INFORMATION WILL ONLY BE EMPLOYED TO HELP DETERMINE THE APPLICANT S ELIGIBILITY, AND ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE. PARENT S OR GUARDIAN S SIGNATURE DATE