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KLM Scholarship Foundation, Inc. 2017 Book Scholarship Application
Required Qualifications:

1) Graduating high school senior attending a 4 Year Virginia college or a full-time student at a 4 Year Virginia college

2) Between the ages of 17-22 years old

3) Cumulative Grade Point Average (GPA) of 3.0 or better

4) Must be a United States citizen or hold a permanent resident visa card

Application Instructions:

1) Submit online application

2) Mail final, sealed and official transcript to P.O. Box 3081, Henrico, VA 23228

3) If you are a graduating high school senior, mail your college acceptance letter to P.O. Box 3081, Henrico, VA 23228

Deadlines:

-Applications must be submitted online 6/30/17

-Official transcripts and college acceptance letters must be postmarked by 6/30/17

First Name
Middle Name
Last Name
Date of Birth
MM
/
DD
/
YYYY
Gender
Required
Race
Required
Street Address Line 1
Street Address Line 2
City
State
Zip Code
Email Address
Phone Number
(999) 999-9999
High School Name
High School GPA
College Name
College GPA
Type N/A if you are a graduating high school senior
College Major
Type N/A if you are a graduating high school senior
2017-18 Classification
List other scholarship(s) awarded and the amount(s):
Have you been approved for Financial Aid (Federal or State)?
Father's First Name
Father's Last Name
Father's Highest Level of Education
Father's Occupation
Father's Employer
Father's Annual Salary
Father's Phone Number
(999) 999-9999
Father's Email Address
Mother's First Name
Mother's Last Name
Mother's Highest Level of Education
Mother's Occupation
Mother's Employer
Mother's Annual Salary
Mother's Phone Number
(999) 999-9999
Mother's Email Address
Are you a first-generation college student?
Total number of household family members currently attending college.
What are your career goals? How will a college education help you achieve your goals?
Describe any honors or awards that you have received within the last two (2) years.
Describe your current and past extracurricular activities and employment history (include leadership roles).
Describe your current and past community service activities.
Are you and/or your family facing financial challenges? If yes, please explain.
What would be the impact if you did not receive a book scholarship?
If you are financially able, would you consider providing a scholarship award to a Virginia college student post graduation? Please explain your answer.
Have you, or anyone in your family, previously received a book scholarship? If yes, please provide examples of how you and/or your family have supported our fundraisers.
Has anyone in your family served as a sponsor for our organization? If yes, please provide examples.
I have been referred by:
Include First and Last Name
I authorize the KLM Scholarship Foundation to review information pertaining to my enrollment status and GPA (e.g. transcript).
If I am selected to receive a book scholarship, I understand that I am required to attend the KLM Scholarship Foundation Awards Ceremony (August 2017) to accept the award.
I grant the KLM Scholarship Foundation permission to use my name and photographic image if I receive a book scholarship.
If I receive a book scholarship, I will participate in fundraising activities if requested.
If I receive a book scholarship, I will immediately notify the KLM Scholarship Foundation in writing if I withdraw from school.
I am a US citizen or hold a permanent resident visa card.
I am a member of Delta Sigma Theta Sorority, Inc. (Virginia State University - Alpha Eta Chapter)
I am a relative of a Nabisco employee.
Provide a reference #1
Include full name
Reference #1 Phone Number
(999) 999-9999
Reference #1 Email Address
Provide a reference #2
Include full name
Reference #2 Phone Number
(999) 999-9999
Reference #2 Email Address
I have answered all questions applicable to me and all information included is true and complete.
Student e-Signature
Include your full name
Parent or Guardian Question: Are you willing to volunteer with our organization?
We welcome and appreciate parental volunteerism and hope that you will be kind enough to lend your time and talents.
Parent or Guardian e-Signature
Include your full name
Submit
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