Danita L. Dickens Memorial Scholarship Application Form
Please complete the form below and submit the following items:

1. An official high school transcript
2. Two letters of recommendation (one from a teacher and one from a counselor, community leader, or employer)
3. Copies of awards, certificates received for Academic Honors, Extra-Curricular Activities/Clubs, Service Learning /Community Outreach (Freshman – Senior years)
4. Copy of class schedule/bill from your accredited university/college
5. Required essay - provided below

All required materials MUST BE RECEIVED by Sunday, June 4, 2017. They can be submitted at the Concierge Desk or emailed to moedanitaldickensscholarship@gmail.com.

Please note Letters of Recommendation can be emailed to moedanitaldickensscholarship@gmail.com by the individual completing the recommendation. Recommendation EMAILS WILL NOT BE ACCEPTED FROM THE APPLICANT DIRECTLY Subject of email should say: DLD Scholarship Recommendation for (Applicant's Name).

Applicant’s Full Name
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Sex
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Date of Birth
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Address
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City
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State
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Zip Code
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Phone
Best number to contact the applicant.
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Email
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Parent/Guardian Name(s)
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Parent/Guardian Contact Number(s)
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Name of High School Attended
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Date of Graduation
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Name of University/College you will be attending this school year: (August – May)
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Expected Date of College Graduation
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Will you be a full-time student?
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I certify that all statements made in this application are true, complete and correct to the best of my knowledge and belief, and are made in good faith.
Selecting YES to this question means the above statement is true.
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Please enter today's date.
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