NAACP Irving – Carrollton Branch
Jearlene Miller Scholarship Application
The $500 Book Scholarship is available to a senior in an Irving ISD or a Carrollton ISD high school.
The following criteria shall be utilized when selecting recipients:
1. Essay: "What position in life do you hope to have in five years and what do you need to do to
accomplish this goal?" – 2 Typed Pages, Times New Roman, 12 font, double-spaced typed (30%)
2. Community Service (30%)
3. Leadership Experience (25%)
4. Completeness of Application (15%)
Scholarship funds will be sent to the college upon proof of enrollment.
PART I.
Personal Data
A. NAME (Please print)
_________________________________________________________________________________
(Last)
(First)
(Middle Initial)
B. PERMANENT MAILING ADDRESS:
_____________________________________________________________________________________
(Street)
(City/Town)
_________________________________________________________________________________
(State)
(Zip Code)
(County)
(Telephone Number)
(Email Address)
C. HIGH SCHOOL FROM WHICH YOU PLAN TO GRADUATE:
________________________________________________________________________________
D. LOCATION OF SCHOOL:
_____________________________________________________________________________________
(City/Town)
(State)
(County)
E. DATE OF EXPECTED HIGH SCHOOL GRADUATION:
F. INTENDED COLLEGE MAJOR:
G. PARENTS' INFORMATION:
□ Father
□ Legal Guardian
□ Mother
Name
Name
Address
Address
□ Legal Guardian
I.
STUDENT’S OTHER INFORMATION:
Date you expect to complete your undergraduate college degree: Month
Year
Your expected enrollment status during the next school year:
Full-time
Part-time
Intended College Major _________________
J. CERTIFICATION:
I understand all of the requirements and conditions of NAACP Irving – Carrollton Branch
Book Scholarship. All of the information submitted is true, complete, and prepared by me.
/
/
Month/Day/Year
Student’s Signature
I approve the applicant’s application for the NAACP Irving – Carrollton Branch Book
Scholarship.
Parent or Guardian Signature
PART II.
Month/Day/Year
Relationship
REFERENCES
Each application must be accompanied by one letter of reference from a high school teacher in
whose class the student is currently enrolled, or the high school counselor who has worked with the
student during the junior and/or senior years. The letter should describe the student's character,
general attributes, and support for the scholarship.
PART III. EXTRACURRICULA ACTIVITIES
A list of extracurricular activities in which the applicant has participated during the junior and senior
years in high school, including athletics, class organizations, student publications, dramatics, debating,
music, church, community, and volunteer activities in a non-school setting. On a separate sheet of
paper, describe level of participation and leadership roles in these activities.
Must Be Postmarked by Ma rc h 27 , 2 01 7 to:
NAACP IRVING-CARROLLTON BRANCH
P. O. BOX 166253
Irving, TX 75016
972-259-3909
THE INFORMATION BELOW PROVIDED BY NAACP RATING OFFICIAL
Essay Score _____ Community Service _____ Leadership _____ Completeness of Application _____
TOTAL SCORE_____
Rating Official Signature __________________________________________________