New Jersey Association of Black Social
Workers Scholarship Application
Eligibility Requirements
Minimum GPA: 3.0
Residency Status: U.S. Citizen
Ethnicities: African American/Black
Academic Classification: Entering Freshman
Majors: Social Sciences
You must submit your materials through the on-line application system. Once you have completed the application
email your application to : [email protected]. If you have any questions regarding this application please
contact Drewsilla Thorne, Scholarship Chairperson at [email protected]. Please include your contact
information in all correspondence.
Deadline: April 15, 2015
I,
have read and understand the conditions of the New Jersey Association of
Black
SocialaWorkers
as explainedddd
Of Black Social Worker. I affirm that I plan
to pursue
career in Scholarship
social sciences.
I give permission to officials of
my institution to release transcripts of my academic record and other information requested for consideration in the New
Jersey Association of Black Social Workers Scholarship. I understand that this application will be available only to
qualified people who need to see it in the course of their duties. I waive the right to access letters of recommendation
written on my behalf. I affirm the information contained herein is true and accurate to the best of my knowledge and
belief.
Date
Signature
Legal name in full
Last Name
(Print/Type)
First Name
M.I.
Permanent residence
Number, Street, and Apartment Number
City
State
ZIP
State
ZIP
Your address at school
(if known)
Number, Street, and Apartment Number
City (if studying abroad, add country)
How is permanent residence established?
(At least two must apply.)
Home address for school registration
Place of registration to vote
Family’s Primary residence
Other:
Home telephone
(
)
School telephone
(
)
(if known)
E-mail address
Age
Date of birth
Month/Day/Year
(Check one) I am a
U.S. citizen
U.S. national
Name of High School
Current cumulative GPA
on a scale of
Your undergraduate major(s)
Application – page 1 of 5
Resident alien expecting citizenship by the date of award
Name
____
1.
List all higher education institutions to which you are applying.
____
School
Location
Dates Applied
____
____
____
____
____
____
____
____
2.
____List high school activities (student government, sports, publications, school-sponsored community service
____programs, student-faculty committees, arts, music, etc.).
____
____
___
3. List public service and community activities (homeless services, environmental protection/conservation,
advocacy activities, work with religious organizations, etc.). Do not repeat items listed previously. # of Weeks
Activity
Role
Application – 2 of 5
Dates
Active
Name
4. List part-time jobs
Type of Work
Employer
5. List awards, scholarships, or special recognitions you have received.
6. Describe one specific example of your leadership.
Application – page 3 of 5
Dates
Average # of
Hours/Week
Name
Approved for use through 08/03
7. Describe a recent particularly satisfying public service activity (do not repeat experience described in 7).
8. Describe the problems or needs of society you feel need to be addressed.
9. Select one of these problems and describe how you would address it.
10. If selected as a New Jersey Association of Black Social Workers Scholar, would you be willing to volunteer for
NJABSW community service activities.
Application – page 4 of 5
Name
12. Describe the education program you intend to pursue if you receive a New Jersey Association of Black Social
Workers Scholarship.
13. What do you hope to do and what position do you hope to have upon completing your studies?
14. What do you hope to do and what position do you hope to have five to seven years later?
15. What additional personal information do you wish to share with the New Jersey Association of Black Social
Workers?
16. Letters of recommendations: Please submitted two letters of recommendation to [email protected].
Letters must be submitted directly from the author of the letter, not the applicant.
Application – page 5 of 5