APPLICATION FOR PROSPECTIVE
COLLEGE STUDENTS
Bill Dickey Scholarship Association (BDSA)
Formerly National Minority Junior Golf Scholarship Association
1140 E. Washington Street, Suite 103
Phoenix, AZ 85034
Phone: (602) 258-7851
tjohnson@nmjgsa.org
Bill Dickey Scholarship Association
PROSPECTIVE COLLEGE STUDENTS
APPLICATION GUIDELINES
(Detach this page and keep it for your records)
Scholarships and one-year grants will be awarded concurrently with awards jointly supported by the Jackie Robinson Foundation, PGA of America and other cooperating organizations.
The primary criteria used to select winners will include scholarship, personal recommendations, participation in golf, school and community activities and financial need. Employment, extracurricular activities, and other responsibilities will be considered under the criterion of school and community activities.
The response to the essay question on page 2 of the application form should be typewritten on white 8 ½ x 11 inch paper. (Put your name and social security number on each page).
The enclosed reference forms should be completed by your high school principal, guidance counselor, or a person who is knowledgeable of your: (A) HIGH SCHOOL EXPERIENCE, (B) HISTORY OF ACTIVE PARTICIPATION IN GOLF, (C) POTENTIAL FOR SUCCESSFUL COLLEGE LEVEL STUDY, AND (D) NEED FOR FINANCIAL ASSISTANCE FOR COLLEGE EXPENSES. The completed reference forms must be returned with your application.
The deadline for this application and all other items is April 16, 2007.
Award checks will be sent directly to the colleges and universities indicated by the recipients and deducted from their registration and tuition costs. All applicants will be notified in writing of the results. The award check will be in your name and the name of the institution.
IMPORTANT REMINDERS
To be complete your application must:
Be signed and dated
Include a copy of your high school transcripts
Contain the one page essay described on page 2 of the application form
Include one head shot photo (3x5)
Contain the two references requested in item 4 above
** Failure to accurately complete the application or return the application on time, may adversely affect rewards.
MAIL APPLICATION TO:
The Bill Dickey Scholarship Association
Formerly National Minority Junior Golf Scholarship Association
Attention: Scholarship Committee
1140 E. Washington Street, Suite 103
Phoenix, AZ 85034
Bill Dickey Scholarship Application
(Please Type)
NAME: _______________________________________SOCIAL SECURITY #: ______________________
Last Name, First Name, Middle Name
HOME ADDRESS: ___________________________________PHONE: _____________________________
CITY AND STATE ________________________________________________________________________
DATE OF BIRTH: ______________________________BIRTHPLACE: ____________________________
Sex: Male q Female q E-MAIL ADDRESS: _____________________________
Ethnic Data: Put appropriate number in the box.
1. African-American 3. Asian/Pacific Islander 5. Other ______________________
2. Hispanic 4. American Indian/Alaskan Native
Grade Point Average Size of Graduating Class ; Class Rank
Have you taken the SAT or ACT Test? q Yes q No
If yes, please indicate score: SAT ________ ACT ________
Current High School _________________________________Phone (_____) ________________________
Address ___________________________________________City ________________________________
State ______________________________________________Zip _________________________________
College or University you plan to attend next academic year _________________________________________
Intended Major ______________________________________
Are you employed? q Yes q No If yes, how many hours per week? ____________________
Job responsibilities _______________________________________________________________________
FINANCIAL INFORMATION:
Approximately how much will it cost for you to attend college per year, including:
Tuition ____________
Room and Board ____________
Books ____________
Total cost: ____________
How much financial support do you expect your family to provide per year? $____________
Father’s Name ____________________________ Mother’s Name _______________________________
Mailing Address __________________________ Mailing Address _______________________________
City/State/Zip ____________________________ City/State/Zip _________________________________
Father’s Occupation _______________________ Mother’s Occupation ___________________________
Number of brothers and sisters __________ How many are currently attending college? ______________
A.
B. List significant extracurricular activities that you have been involved in over the past two years. Check (ü ) the grade(s)
|
ACTIVITIES |
11th Grade |
12th Grade |
List Leadership Position(s)/Hours |
C.
D.
I hereby certify that the information provided in this application is complete and correct to the best of my knowledge.
Signature of Applicant Date
PERSONAL REFERENCE FORM
Bill Dickey Scholarship Association
Formerly National Minority Junior Golf Scholarship Association
1140 E. Washington Street ∙ Suite 103 ∙ Phoenix, AZ 85034 ∙ Phone: 602.258.7851
SCHOLARSHIP GRANTS
NAME OF APPLICANT _________________________ _______________________ ___________
Last name First name Middle initial
SOCIAL SECURITY NUMBER ___________________________
As a reference please provide a response to each of the following questions. If you need more space, use the back of this form. Please type or write legibly.
How long have you know the applicant and in what capacity?
Why do you believe the applicant will be successful in a professional career?
What is your assessment of the applicant’s academic ability?
What is your assessment of the applicant’s community service or involvement?
Describe the applicant’s participation in golf to the extent of you knowledge.
Are there any unique factors that make the applicant especially worthy of receiving academic support? (special talents, need for financial assistance, single-parent income, etc.
YOUR NAME _____________________________________ POSITION/TITLE ________________________
ADDRESS ________________________________CITY______________ST_______ZIP_________________
PHONE _______________________ SIGNATURE ________________________________ DATE _________
This form is to be returned with the scholarship application.
PERSONAL REFERENCE FORM
Bill Dickey Scholarship Association
Formerly National Minority Junior Golf Scholarship Association
1140 E. Washington Street ∙ Suite 103 ∙ Phoenix, AZ 85034 ∙ Phone: 602.258.7851
SCHOLARSHIP GRANTS
NAME OF APPLICANT _______________________________ _______________________ ___________
Last name First name ; Middle initial
SOCIAL SECURITY NUMBER ___________________________
As a reference please provide a response to each of the following questions. If you need more space, use the back of this form. Please type or write legibly.
How long have you know the applicant and in what capacity?
Why do you believe the applicant will be successful in a professional career?
What is your assessment of the applicant’s academic ability?
What is your assessment of the applicant’s community service or involvement?
Describe the applicant’s participation in golf to the extent of you knowledge.
Are there any unique factors that make the applicant especially worthy of receiving academic support? (special talents, need for financial assistance, single-parent income, etc.)
YOUR NAME _____________________________________ POSITION/TITLE ________________________
ADDRESS ________________________________CITY______________ST_______ZIP_________________
PHONE _______________________ SIGNATURE ________________________________ DATE _________
This form is to be returned with the scholarship application.