Thurgood Marshall College Fund/Wal-Mart Foundation First Generation Scholars Program Application
General Information: (please print or type)
Last Name: Name of TMCF Member Institution: Social Security #: Major/Anticipated area of study: Date of enrollment: SAT/ACT: Are you a U.S. citizen? Anticipated Graduation Date: GPA Ethnic Origin (optional): First Name: _____________________ Date of Birth: Middle Initial:
Are you the first in your family to attend college (Y/N)?
Student Contact Information
Student’s Address (campus): Street Address: City: Phone: State: Email: Apt#/POB: Zip:
Student’s Address (permanent): Street Address: City: Phone: State: Email: Apt#/POB: Zip:
Name of Parent/Guardian:
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Street Address: City: Relationship to you: State: Phone:
Apt#/POB: Zip:
Name of Additional Contact: (if different from above) Street Address: City: Relationship to you: Name of Emergency Contact: (if different from above) Street Address: City: Relationship to you: State: Phone: Apt#/POB: Zip: State: Phone: Apt#/POB: Zip:
Financial Statement
PLEASE NOTE: The FAFSA is optional, although we suggest submitting this form as it is commonly used in many institutions. The FAFSA is available in paper and electronic formats. You can obtain the paper version from the financial aid office at any college or university, the public library, or by calling 1-800-4-FEDAID. If you prefer, you can fill out a web-based version of the FAFSA at http://www.fafsa.ed.gov (step-bystep instructions are provided on the site). Full Name of Mother/Guardian: Full Name of Father/Guardian: Mother’s Occupation: Father’s Occupation:
Are you supported by your parent (s) 50% or more, or do you live with them? Yes____ No ____ Number of Dependents your parents support 50% or more:______ Number of Siblings attending College:______ ____I have attached a completed FAFSA (Free Application for Federal Student Aid) form, along with the supporting documentation (optional). If you are considered a dependent student, please indicate the approximate annual income of your family: $10,000 or less $30,000 - $40,000 $10,000 - $20,000 $20,000 - $30,000 $40,000 - $50,000 $50,000 or more
Do you anticipate receiving any of the following: (please check any that apply) Stafford Loan College Work Study Guaranteed Student Loan (GSL) Other (Please Specify): Pell Grant National Direct Student Loan (NDSL) State Student Incentive Grant
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Enrollment and Certification Form
To be completed by the college or university’s designated TMCF Scholarship Coordinator. Current GPA: Cumulative GPA
Anticipated costs of tuition, books, room and board for this semester: $ Value of other Awards and sources: (please list) ___________________________ ___________________________ ____________________________
Amount Requested from TMCF/Wal-Mart this academic year: $ I, hereby, verify the academic standing of the aforementioned Thurgood Marshall Scholar, who is enrolled as a full-time student.
Name of Representative
Signature
Date
Personal Information
Please list information or include details about the following (please type on a separate sheet(s) and attach): School Related Activities: _________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Honors and/or Awards: ___________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Hobbies, talents, special interests: __________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Professional Experience / Work History: ______________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ What is your primary career goal?___________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________
Student Essay (attach essay on separate page)
In 250 words or less, please explain one or more of the following: What does it mean to be the first in your family to attain a college degree? How will an award from the Thurgood Marshall College Fund/ Wal-Mart Foundation help make a difference in completing your degree?
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Letter of Recommendation
Please attach at least one letter of recommendation from, but not limited to, former teachers, college administrators, community leaders or other similar persons concerning the academic ability, character, reputation or professional aptitude of the applicant.
Student Information / Family Background
Has any member of your family, other than yourself, ever attended a TMCF member institution? If yes, please give the name and address of the member, name the institution, and note year of graduation.
Name of Family Alumni: School Attended: Street Address: City: Phone:
Relationship to You: Graduation Date: Apt#/POB: State: Zip:
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_______
Name of Family Alumni: School Attended: Street Address: City: Phone:
Relationship to You: Graduation Date: Apt#/POB: State: Zip:
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_______
Name of Family Alumni: School Attended: Street Address: City: Phone:
Relationship to You: Graduation Date: Apt#/POB: State: Zip:
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_______
Please give the name and city of the Church or Religious Institution you attend. (optional) Church/Religious Institution: Street Address: City: State: Zip: _______
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Please list the name and address of any other personal references: (optional) Name: School Attended: Street Address: City: State: Relationship to You: Graduation Date: Apt#/POB: Zip: _______
Name: School Attended: Street Address: City:
Relationship to You: Graduation Date: Apt#/POB: State: Zip: _______
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Acceptance Form I affirm that, to the best of my knowledge, all information provided by me on this application is current and correct. I agree to submit a black and white or color photo of myself, which I authorize TMCF to use for publicity purposes and I agree to have my contact information released to the Wal-Mart Foundation in the event that the foundation would like to contact me personally. If I am awarded a scholarship offered by college or university through the Thurgood Marshall College Fund, I understand that continuation of my scholarship is not automatic and contingent on available funding. I understand that TMCF payment procedures are based on a calendar year; TMCF disburses st funds on December 31 , which is sent directly to the Institution. Additionally, I understand that in order to remain eligible for funding, I must comply with the following requirements for the duration of my scholarship: Maintain a current and cumulative GPA of 2.5; Maintain full-time status at the participating institution; Continue pursuing a degree in the field of study specified (if applicable) in the criteria; Keep the coordinator informed of any changes in academic standing, or major plans to modify enrollment; Provide current address, phone number and email address to TMCF at the beginning of each school year. I have read and fully understand the above requirements and I agree to abide by them. Applicant’s Signature Date
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Application Check List
Don’t forget to include the following:
Completed Application including Financial Statement, Personal Information, Acceptance Form 250-word student essay Photograph (Black and White Headshot preferred) Copy of high school or current college transcript A completed student resume At least one letter of recommendation
Please submit your application with the required attachments to the designated TMSF Scholarship Coordinator at your college or university listed below. (Please contact the TMSF Programs Department should you have difficulty reaching a TMSF Scholarship Coordinator).
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