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							                                           Jacksonville State University
                                          Department of Criminal Justice
                                        CCCBA SCHOLARSHIP PROGRAM

                                  Funded by the Calhoun/Cleburne County Bar Association.

Jacksonville State University and the Calhoun/Cleburne County Bar Association is providing scholarship opportunities for
students in criminal justice degree programs. Students must meet all of the following criteria:
 Be a United States citizen, national, or alien admitted as a refugee at the time of application;
 Be enrolled full time as a Department of Criminal Justice student in the undergraduate program;
 A student must possess a cumulative grade point average (GPA) of at least 2.75 based on a 4.0 scale and/or a 3.0 GPA on a
    4.0 scale in their major studies;
 A transfer student’s eligibility will be based on the same criteria and will be determined by their transcripts from their
    previous institution of higher education;
 Recipient has to have achieved at least junior status (a minimum of 64 hours completed);
 Preference will be given to criminal justice students who were originally from Calhoun or Cleburne County.
                                          PLEASE TYPE OR PRINT LEGIBLY IN INK


Applicant Data

Last Name: _____________________________________ First Name: _________________________ Middle Initial: _________

                Permanent Address                                        School Residential Address
Street: _________________________________________           Street: __________________________________________
City:   _________________________________________           City:   __________________________________________
State: ___________________________ Zip: _________           State: __________________________ Zip: ___________
Telephone: ______________________________________           Telephone: _______________________________________
E-Mail: _________________________________________           E-Mail: __________________________________________

*Social Security Number: ___________________________ Date of birth:           ___________________________________

Ethnicity/Race:                                                   Disability Status:
 Native Hawaiian or Other Pacific Islander                        None
 American Indian or Alaskan Native                                Hearing Impairment
 Hispanic or Latin                                                Mobility/Orthopedic Impairment
 Black or African American, not of Hispanic origin                Learning Disability
 White, not of Hispanic origin                                    Vision Impairment
 Asian                                                            Other, please specify _______________________________
Gender:                                                           Citizenship:
 Male                                                             U.S. Citizen
 Female                                                           National
                                                                   Alien admitted as refugee
                                                                   Other




Transfer Students:       Previous College Attended ____________ College GPA ________           Semester Hours Earned ________

Current JSU Student:     College GPA ___________            Semester Hours Earned __________            Years at JSU _______

                         CJ GPA ___________
Please indicate your program of study at Jacksonville State University:

   BS in Criminal Justice

   New students only: Attach copy of application for admission to Jacksonville State University. Submit a copy of your
    transcript(s) of previous college work or high school transcript as appropriate.

   All Applicants: Please attach a recommendation from a faculty member or have the faculty member mail the recommendation to
    the address indicated below.


I give Jacksonville State University the permission to access my academic records and other records for consideration for the
Department of Criminal Justice Alumni Association Scholarship Program. I affirm that I also plan to receive a degree in Criminal
Justice. If I am chosen as a recipient I will abide by all the rights and responsibilities of the scholarship awards and agreement.

Applicant Signature: _____________________________________________ Date: ______________________________________


               Deadline for receipt of application:
                          June 30, 2011 (for Fall 2011);
                          June 30, 2012 (for Fall 2012);

               Applications can be either mailed or e-mailed to the following addresses:

               Mailing Address: Jacksonville State University
                                ATTN: Scholarships
                                700 Pelham Road North
                                 Jacksonville AL 36265

               E-mail: mweldon@jsu.edu (RE: Scholarship)

                                                        http://www.jsu.edu/criminaljustice/
               For more information: Visit the JSU Web Site at
               Or http://www.jsu.edu/finaid/scholarships/types.html




       Jacksonville State University is committed to equal opportunity in employment and education. The University does
       not discriminate in any program including admission of students and employment on the basis of race, color, national
       origin, sex, religion, age or handicap.

       If you wish to request accommodations under The Americans with Disabilities Act or Section 504 of The
       Rehabilitation Act of 1973, as amended, contact JSU's Office of Disability Support Services at 256-782-5093.

                    *THE STUDENTS SOCIAL SECURITY NUMBER IS CONFIDENTIAL. THE USE OF THE
       SOCIAL SECURITY NUMBER AS STUDENT NUMBER IS VOLUNTARY. HOWEVER, YOUR STUDENT
       NUMBER MUST BE YOUR SOCIAL SECURITY NUMBER IF YOU ARE APPLYING FOR FINANCIAL AID.
       IF A STUDENT DECIDES NOT TO USE HIS/HER SOCIAL SECURITY NUMBER AS THE STUDENT
       NUMBER, HE/SHE MUST NOTIFY IN WRITING THE OFFICE OF ADMISSIONS AND RECORDS OF THIS
       INTENT. ANY SOCIAL SECURITY NUMBER USED AS A STUDENT NUMBER WILL NOT BE RELEASED
       WITHOUT A WRITTEN CONSENT FROM THE STUDENT. AUTHORITY FOR REQUESTING THE
       DISCLOSURE OF A STUDENT'S SOCIAL SECURITY NUMBER IS IN SECTION 7 (a) (2) OF THE PRIVACY
       ACT OF 1974 (5 u.s.c. 522 a).