Alcorn State University Foundation, Inc.

Scholarship Application for 2004 - 2005

Name _______________________________ Social Security # ____________________

Home Address _________________________________________________________________

Campus Address _______________________________________________________________

Home phone _____________________ Campus phone _________________________

Home county ____________________ Hometown newspaper _____________________

Classification (check one) ____ Freshman ____ Sophomore____ Junior ____Senior ____ Graduate

Major ________________________________ Minor (if any) ____________________________

GPA (cumulative/ASU or Transfer)_____ ACT or SAT score (entering freshman) _____

• On the back of this form, check only those scholarships for which you meet the criteria and would like to be considered.
• On a separate sheet, explain why you believe that you satisfy the criteria for this scholarship, what you are planning for your future and why you should be selected to receive this scholarship instead of all the other applicants.

I certify that the information above is true. I understand that I am expected to send a thank you letter to the donor of this scholarship. If asked I will provide service to the university to help secure other donations. I agree that my name may be publicized as the recipient of this scholarship, if selected.

___________________________________            ____________________
Signed                                                                                      Date

DO NOT WRITE BELOW THIS LINE                                                   

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