Dr. Eddie Regnier Graduate Research Scholarship

Application 2023

Date of Application

MM slash DD slash YYYY

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

First Name

Last Name

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Daytime Telephone Number

Date of Birth

MM slash DD slash YYYY

Are you related to any of the members of the Florida Council on the Social Status of Black Men and Boys or staff?

Yes

College/University

A number of years attended

I will be attending the following school in the Fall of 2023

Proof of acceptance or current student enrollment from the above school is required before funds being released to the college or university.

I will be entering the above-mentioned school as a:

Master’s Student

PHD Student

Professional Student

Grade Point Average (GPA) (On a 4.0 scale)

Attach proof of GPA. Your most recent official school transcript required.

Name & address of parent(s) or legal guardian(s): Emergency Contact

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home phone of parents or legal guardians

Date

MM slash DD slash YYYY

List the name of any college you have attended and type of degree received.

Name of college and degree

Year Began

MM slash DD slash YYYY

Year Ended

MM slash DD slash YYYY

Year Graduated

MM slash DD slash YYYY

Name of college and degree

Year Began

MM slash DD slash YYYY

Year Ended

MM slash DD slash YYYY

Year Graduated

MM slash DD slash YYYY

What specialty/major do you plan to major in as you continue your education?

List expenses you expect to incur per semester or quarter: (Approximate figures acceptable)

A. Tuition: Amount: $

B. Books: Amount: $

C. Room & Board: Amount: $

D. Other expenses: Amount: $ Describe below under comments

Comments

List other financial assistance you will receive per semester or quarter: (Other financial assistance will not affect your scholarship eligibility.)

Personal: Amount: $

Other Scholarship(s): Amount: $

Grants: Amount: $

Student Loan(s): Amount: $

Other Financial Resources: Amount: $

Comments

Use an additional sheet if you need more room to list financial information requested in items 14 & 15.

List your community service activities, hobbies, outside interests, and extracurricular activities.

Personal Essay Please answer the following question:
• What are your educational and professional goals and objectives?
• How has attending college impacted your life?
• The lessons we take from obstacles we encounter can be fundamental to later success. Recount a time when you faced a challenge, setback, or failure. How did it affect you, and what did you learn from the experience?
• Describe a topic, idea, or concept you find so engaging that it makes you lose all track of time. Why does it captivate you? What or who do you turn to when you want to learn more?
• This question must be at least 1-2 pages, typed, double-spaced, and 12 pt / Time New Roman font. Please ensure your essay contains no grammatical errors.

A. The following items must be attached to this application for the application to qualify to be reviewed by the scholarship committee.
B. Your application will not be considered 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.

Completed application. All questions are answered completely.

Yes

Writing Sample.

Yes

Two (2) Letters of Recommendation.

Yes

Proof of college acceptance or current student enrollment. Acopy of your college acceptance letter is required for receipt of funds.

Yes

Most recent officialundergraduate or graduate transcripts. Photocopies of your transcript are acceptable if a transcript is signed by a guidance counselor or principal.

Yes

Personal Essay. Must be at least 1-2 pages, typed, double-spaced, and in 12 pt / Time New Roman font. Please ensure your essay contains no grammatical errors.

Yes

Community service hours. Must be documented in the form of a letter on official letterhead from the agency the applicant completed their community service hours.

Yes

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 Foundation’s scholarship program.

I hereby understand that if chosen as a scholarship recipient, according to Anniston Community EducationFoundation Scholarship policy, 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

MM slash DD slash YYYY

Signature of applicant’s guardian/ parent

Date

MM slash DD slash YYYY

Dr. Eddie Regnier Graduate Research Scholarship

STATEMENT OF ACCURACY

"Empowering youth in the designated area with need based Educational Resources."

FLORIDA COUNCIL ON THE
SOCIAL STATUS OF BLACK MEN & BOYS

Dr. Eddie Regnier Graduate Research Scholarship

STATEMENT OF ACCURACY

"Empowering youth in the designated area with need based Educational Resources."

FLORIDA COUNCIL ON THE SOCIAL STATUS OF BLACK MEN & BOYS

FLORIDA COUNCIL ON THE
SOCIAL STATUS OF BLACK MEN & BOYS