Online Application Step 1 of 3 33% Student InformationName* First Last Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date Residence Began* MM slash DD slash YYYY Home Phone*Parental Information*Parent NameParent Occupation From which DCWAF charity have you received benefits?* Financial InformationParent's Combined Adjusted Gross Income, Last Year* Student's Combined Adjusted Gross Income, Last Year* Number of Family Members Currently Enrolled in College* NOTE: IF SELECTED THE APPLICANT MUST SUBMIT IRS FORMS FOR BOTH PARENTS AND THE STUDENT, TO CONFIRM THE ABOVE FINANCIAL DATA.Other Financial Aid*Please list any other form of financial aid applied for or you will be receiving (e.g., scholarships, grants, loans, etc.). Education DataHigh School Attended/Current School* Graduation Date* MM slash DD slash YYYY Composite Scores*ACT ScoreSAT ScoreH.S Grade Point Avg.If you do not have Composite Scores, please describe any academic achievementsSubmit Grades/GPA (if applicable)Higher Learning Institution You Plan To Attend* Institution Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have You Been Accepted to The Institution Above?* Yes No Intended Major* Activities SectionThis section is divided into three parts. Please list each activity only once. Please DO NOT abbreviate. Part A: Work HistoryDescription of paid employment while attending high school, including summers.EmployerSchool YearAvg. Hour Worked Per WeekNumber of Weeks Per School Year Part B: Academic*Academic activities sponsored by high school, I.E. Science Language, Math clubs, etcActivity NameSchool YearOffice Held/Years Held (if any)Hours/Years in Club and Significant Contributions Part C: Non-Academic*Organized volunteer, community, or other activities not sponsored by high school, I.E., Scouts, music, church, hospital, etc. Activity NameSchool YearNumber of Weeks InvolvedSignificant Contributions or Special Recognition EssayPlease prepare a double-spaced, typewritten essay of approximately 250 words on the following topic: “My Educational and Career Objectives.” Place the title with your name and address at the top of the essay, and then attach the essay to this application. Upload Essay*Accepted file types: docx, pdf, doc, txt, jpg, png, gif, jpeg, Max. file size: 512 MB.Release of InformationI hereby authorize the release of information from my high school academic records to members of the Board of Directions of the Ellison McCraney Ingram Foundation, Inc. I understand that the information will be used to determine the awarding of scholarship grants. Are there any factors that could prevent you from fully utilizing this scholarship?Acceptance of Release* Confirm Release Decline Release Your Full Name as Digital Signature* Today's Date* MM slash DD slash YYYY Confirm* I agree that EMIF reserves the right to review the accreditation of any vocational or continuing educational program for validity.EMIF reserves the right to review the accreditation of any vocational or continuing educational program for validity.
