ACADEMIC SCHOLARSHIP & GRANT APPLICATION
Email address
Name
Last Name, First Name
SIU ID Number
Due Dates
All materials MUST be RECEIVED no later than October 24 for consideration.
Applying For
(Check One)
Required
Permanent Address
Street Address
City
State
ZIP
Local Address
Local Street Address
City
State
ZIP
Education
Year in School:
Current G.P.A.
Major
Minor
Community Service
Please list and explain any community service activities (school or non-school related) in which you are actively involved.
Submit one (1) letter of recommendation on official letter head from one of the organizations to document your involvement.
Your Service Activity
Please list all that apply with your role and contribution
Extracurricular Activities
Extracurricular Activities
Please list all that apply. Include your 1) Activity Participation 2) Office Held (If Any) 3) Years of Service
Honors and Awards
Honors & Awards
Please list any Honors or Awards you have received.
PERSONAL STATEMENT
Please upload your answer to the following (One typed page 12pt double spaced)

1) As you reflect on your experience at Southern Illinois University, explain which of your community service activities has had the greatest impact on your life and why.

2) Please state why you believe you deserve to be awarded the Black Alumni Group scholarship/grant.

Personal Statement
Required
Verify
Required
Full Name and SIU Email
Date
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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This form was created inside of SIUC Black Alumni Group. - Terms of Service - Additional Terms