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									                                 Jones-Whitehead
                             Scholarship Award Program
                                                      Purpose:
 To provide a scholarship(s) to deserving members of the Jones-Whitehead Family that has chosen to pursue a post-
secondary education.

                                               Award Components:
Two (2) $500 scholarships awarded to Two (2) students/family member selected by the Jones-Whitehead Scholarship
Committee.
                                                     Criteria:

       1.     Applicant must be a member of the Jones or Whitehead family.
              Applicant must be a graduating high school senior or a current undergrad or graduate student.

       2.     Applicant must submit a 500 minimum word essay on the topic chosen by the scholarship committee in
              order to be considered for the scholarship.


                                                Application Process:
                                      Applicant must submit the following items:

       1.      Completed application form (if handwritten, please print legibly)
       2.      An acceptance letter or an official transcript
       3.      Personal Essay. In your essay, please answer the topic question
              (500 word Minimum)

                                 How have you made a positive difference in your community?


If you have any questions about the application, please contact the Scholarship Committee Chair Keyia Matthews at
(804) 504-3000 or via e-mail at smatthews@genesis-img.com

       NOTE: Scholarship awards are to be applied “ONLY” towards tuition; fees, books, supplies
       and/or equipment required for the courses at the educational institution that the applicant(s)
       attends or will be attending. Scholarship awards will be paid in the form of a check directly to
       the institution.
                                                       Deadline
                     All applications are due Friday, April 1, 2011, by 5:00 p.m. (No exceptions)
                     Applications can be submitted by e-mail to the Scholarship Committee Chair

 smatthews@genesis-img.com (in the subject line please write: Jones-Whitehead Scholarship Award Program)

                            If the application is submitted by mail please send to:

                                                Keyia Matthews
                                            17249 Connor Quay Court
                                              Cornelius, NC 28031
                                                                                                                    1
                                          Jones-Whitehead Scholarship Award
                                              Application 2011 / 2012


Please type or print your answers. If application is illegible it will be returned to you.

1.    Last Name:                                                             First Name:

2.    Mailing Address::
                     Street: _________________________________________________________

                          City:                                State:                         ZIP:


3.    Email:

4.    Daytime or Cell Telephone Number: (                     )

5.    Date of Birth:     Month                          Day                         Year

                                                                                                                 Number of years
6.    Current College/University or Vocational institution:                                                      attended:



7.    I will be attending the following school in the Fall of 2011: _______________________________________

      Proof of acceptance or official transcript from the above school is required prior to scholarship award.

8.    I will be entering or continuing my education at the above-mentioned school as a: (Circle one)

      Freshman           Sophomore             Junior          Senior          Graduate Student


9.    Grade Point Average (GPA): __________                 (On a 4.0 scale)
      Attach proof of GPA. Your most recent official school transcript required.
10.
      List your academic honors, awards and membership activities:



11.
      List your community service activities:


12.
       If you are awarded the scholarship what would you apply the funds towards:




                                                                                                                                   2
 13.    Personal Essay
        Please answer the following question:
        How have you made a positive difference in your community?
        Submit your response on the last sheet provided with this application.


  14.   A. The following items must be attached to this application in order for the application to qualify to be
        reviewed by the scholarship committee.
        B. Your application will NOT be reviewed if these items are not attached to this application. (No exceptions.)
        C. Circle “YES” or “NO” to be sure you have attached each item as required.

        YES    NO     Proof of college acceptance or current school transcript. A letter of college acceptance or
                      program acceptance is required or an official school transcript.

        YES    NO     Personal Essay (500 word minimum)




                                            STATEMENT OF ACCURACY

I hereby affirm that all the above stated information provided by me is true and correct to the best of my knowledge. I
also consent that my picture may be taken and used for any purpose deemed necessary to promote the Jones-
Whitehead Scholarship Award Program.

I hereby understand that if chosen as a scholarship recipient, according to Jones-Whitehead Scholarship Guidelines, I
must provide evidence of enrollment/registration at the post-secondary institution of my choice before scholarship
funds can be awarded.


Signature of scholarship applicant: _________________________________            Date: _______________________



                                                     REMEMBER

The deadline for this application to be received by the Jones-Whitehead Scholarship Committee is
                                    Friday April 1, 2011, 5:00 p.m. No exceptions




                                      Jones-Whitehead Scholarship Award
                                            Application 2011 / 2012

                                                   Personal Essay

                 How have you made a positive difference in your community?




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