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									THE CHUCK BURCH SCHOLARSHIP FUND
1112 Marisa Lane DeSoto, TX 75115 (972) 230-1551

Criteria for Chuck Burch Scholarship The Chuck Burch Scholarship fund will award a scholarship to a student from the Dallas/Ft. Worth area. The scholarship will be awarded in the fall of the academic year of the student’s freshman year and be payable ½ ($1,000) in the fall and ½ ($1,000) in spring. The scholarship is not renewable and is for 1 year only. The maximum scholarship awarded to an individual under this program will be $2,000.00. Requirements In order to be considered you must be: A minority graduating high school senior at a high school in the Dallas/Ft. Worth, Texas Metroplex A student who has applied and been accepted as an incoming freshman at North Carolina A&T State University A citizen of the United States Funds are to be payable to "North Carolina A&T State University" for the awardee's account and They are to be used for tuition, books, or room and board only Student must not be a recipient of a full academic or athletic scholarship to North Carolina A&T State University Student must demonstrate a financial need for the funds as evaluated by the Scholarship committee Criteria is based on a combination of academic performance, extracurricular activity and financial need To apply

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1. Complete the enclosed application and attach copy of transcript. 3. Mail application to: Octavia Jones C/o The Chuck Burch Scholarship Fund 1629 Nightingale Lane Lewisville, TX 75067 If there are any questions, please call 972 966-0065 or 972 230-1551 or E-Mail at Chuck.Burch@hotmail.com All applications must be received by August of the calendar year applied for The independent scholarship committee currently consists of Octavia Jones, Quentin Jones and Mysti Dennis. All North Carolina A&T graduates residing in the State of Texas. Individuals may rotate on and off the committee on an annual basis.

THE CHUCK BURCH SCHOLARSHIP FUND
1112 Marisa Lane DeSoto, TX 75115 (972) 230-1551

SCHOLARSHIP APPLICATION 20__ - 20__ Academic Year
General Information
Please type or print Social Security #_ _ _-_ _ _-_ _ _ _ Date of Birth _ _-_ _ _ _ Name of Applicant Last Address of Applicant City State Zip Telephone: Home (____) ____ - _____ Work (____) ____ - _____ U.S. Citizen Yes ___ No ___ First Initial

Please indicate your minority group African American ____ Native American ___ Asian American ____ Hispanic ___ Other (Please Specify) __________________

Academic Information
(Please attach copy of Transcript(s)

Name of High School Date of High School Graduation Achievement Test/Score Anticipated Major Anticipated Undergraduate Graduation Date High School Counselor

City GPA SAT

State Class Rank

Telephone (____) _______

ACT Combined/Composite

If attended other High Schools please list and attach copies of transcripts

THE CHUCK BURCH SCHOLARSHIP FUND
1112 Marisa Lane DeSoto, TX 75115 (972) 230-1551

Personal Information
Please List: 1. School Related Activities 2. Honors and Achievements

3.

Hobbies, Talents and Special Interests

4.

What is your primary career goal?

5.

If you intend to enroll in graduate/professional School, what is the highest degree level you would like to achieve? Degree Discipline

Financial Aid Information
If you are considered a dependent student, please indicate the approximate annual income of your family. ___$10,000 or less ___$10,000 - $20,000 ___$20,000 - $30,000 ___$30,000 - $40,000 ___$40,000 - $50,000 ___$50,000 or more

Do you anticipate receiving any of the following awards? (Check all that apply) ___Pell Grant ___National Direct Student Loan ___State Student Incentive Grant ___College Work Study ___Guaranteed Student Loan ___None of the Above

Have you been awarded any other scholarships or grants? (List Name, Type and Amount)

Do you plan on working to help cover the expenses of your education? ___Yes ___No If yes, approximately how much of your expenses will you pay? ________ Parent's Occupation Mother Father Education (Circle one) High School College High School College

Masters Ph.D. Masters Ph.D.

Do you have any brothers or sisters in College? If so, please give the following information. Name Institution Year Major

The Chuck Burch Scholarship Application

THE CHUCK BURCH SCHOLARSHIP FUND
1112 Marisa Lane DeSoto, TX 75115 (972) 230-1551

Letter of Recommendation
Recommendation for High School Attach additional sheets if necessary.

Name and Title Address Telephone Signature The Chuck Burch Scholarship Application

THE CHUCK BURCH SCHOLARSHIP FUND
1112 Marisa Lane DeSoto, TX 75115 (972) 230-1551

ESSAY
In the space provided below, please write or type how the Chuck Burch Scholarship will make a difference in your ability to become academically and professionally successful. (You may attach a separate sheet of paper if desired)

Date received _______

Rank ___

For Scholarship Committee use only Reviewed by _________________


								
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