Theta Nu Xi Multicultural Sorority, Incorporated
Xi Theta Chapter Scholarship
Full Name:
Address:
City:
State:
Zip:
Phone Number:
Email Address:
High School:
Have you bee accepted at a 4 Year College or University? Yes
If Yes, Which one?
What do you intend to be your major course of study?
No
Please list and tell us about your leadership roles in any of these activities (attach additional
page if necessary):
Community Activities:
Extracurricular:
Work:
Other Commitments:
Honors or Special Community Recognition:
Essay: In 500 words or less, please answer the following question:
How has society affected how you value multiculturalism?
Attach the following along with this application:
*Current High School Transcript from Guidance Department
* Copy of College/University acceptance Letter
*Essay
Mail Application to: Xi Theta Scholarship Fund, c/o Tiffany Worthen, 3917 Cobb St, Garner, NC
27529
Or
Email in ONE PDF file to [email protected]
***DUE APRIL 30, 2015***
I herby certify that the information provided is complete and accurate to the best of my knowledge. I further authorize
release of any information from any organization, agency, company or institution where necessary for verification
Applicant’s Signature:
Date:
Parent/Guardian Signature (if applicant is under 18):
Parent/Guardian Name (please print):