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

DOCUMENT SUBMISSION:
All required documents MUST BE RECEIVED by Sunday, June 30, 2019. They can be emailed to moedanitaldickensscholarship@gmail.com or submitted at the Concierge Desk (envelope addressed to Bro. Aaron Williams/DLD Scholarship)

LETTERS OF RECOMMENDATION:
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).

Email address *
Applicant’s Full Name *
Your answer
Sex *
Required
Date of Birth *
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Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone *
Best number to contact the applicant.
Your answer
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Contact Number(s) *
Your answer
Name of High School Attended *
Your answer
Date of Graduation *
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Name of University/College you will be attending this school year: (August – May) *
Your answer
Expected Date of College Graduation *
Your answer
Will you be a full-time student? *
Required
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.
Required
Please enter today's date. *
Your answer
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