John Holmes Memorial Bridge Academic Grants
Please go over your application carefully. Any application that is not complete or does not include all of the supporting documentation will be disqualified.
Email *
Name *
Last Name, First Name
SIU ID Number *
Local Address
Local Street Address (Street, City, State, ZIP) *
Permanent Address
Street *
City *
State *
Year in School: *
Cumulative G.P.A. *
Major *
Minor (or enter none) *
Community Service
Please list and explain any community service activities (school or non-school related) in which you are actively involved.
Your Service Activity
Service Dates
Total Volunteer Hours
Volunteer Organizations
Letter of References
Professor/Instructor Reference #1 Name
Reference #1 Email
Reference #1 Phone
Professor/Instructor Reference #2 Name
Reference #2 Email
Reference #2 Phone
Submit one (2) letter of recommendation on official letter head from one of the organizations to document your involvement. *
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.
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 *
Full Name and SIU Email *
Due Dates
All materials MUST be RECEIVED no later than Friday May 4, for consideration.
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