SOUTHERN UNIVERSITY ALUMNI

SOUTHERN UNIVERSITY ALUMNI--HOUSTON CHAPTER
APPLICATION
for
ACADEMIC SCHOLARSHIP

Directions: Please completely fill in this form, print it out, and mail it along with your application package.

CATEGORY:

Indicate the scholarship category(s) for which you are qualified and wish to be considered:

Freshman Scholarship Upperclassman Scholarship HBCU Scholarship (other than Southern) Laptop Computer

PERSONAL DATA:

First Name MI Last Name

Home Address

City Zip Code

Home Phone Number

High School Name

School Address

City Zip Code

School Phone Number

Student's E-Mail Address

Any relatives SU graduates? Yes No

Name of relative:

EDUCATION:

Current GPA

Year of High School Graduation:

ACT Score

SAT Score

Anticipated Major

PARENT/GUARDIAN INFORMATION:

Name of Parent or Guardian:

Address (if different from student home address)

City Zip Code

Phone