Leila Green Alliance of Black School Educators (LGABSE) Scholarship Application P.O. Box 9564 * Canton, Ohio 44711-9564

The Leila Green Alliance of Black School Educators will award a $500 scholarship to (1) African-American graduating senior of McKinley Senior High School. The application form must be completed and returned to the address above NO LATER THAN WEDNESDAY, MARCH 22ND, 2017. To be eligible for the scholarship the applicant must:  Be an African-American graduating senior from the Canton City School District  Have an accumulative GPA no less than 2.5

Be sure to complete all information requested on the application form as well as: 1. The typed or legibly printed application form. (Add sheet (s) if additional space is needed) 2. An official transcript of grades. 3. Two (2) letters of recommendation. (one letter from school personnel and one letter from anyone NOT related to you such as pastor, employer, family friend etc.) 4. An essay of no less than 300 words that is typed and double spaced. This essay will tell what you plan to achieve with a college degree.

Please return completed application and items 1-4 in one envelope by Wednesday, March 22, 2017

Leila Green Alliance of Black School Educators Application

First/Last Name_____________________________________________________ Address____________________________________________________________ Phone__________________________E-mail______________________________ Father’s Name___________________________________________living___deceased___ Mother’s Name___________________________________________living___deceased___ Guardian’s name ____________________________________________________ NAME OF HIGH SCHOOL:______________________________________________ GRADUATION DATE:__________________________________________________ High School Activities/# of Years Participated/Leadership Offices (sports, clubs, etc.) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Community Activities/# of Years Participated /Leadership Offices (church groups, scouts, volunteer work, etc.) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Work History________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ How will this scholarship help meet your financial need? ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Academic Awards and/or Honors_____________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ What is your current cumulative Grade Point Average?_____________________ What is your proposed college major?___________________________________

Have you been accepted by any college or university?___ Please list if applicable Name of Institution

Location

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

The following people have been asked to write a letter of recommendation: Name

Telephone Number

________________________________

_________________________

________________________________

_________________________

I hereby apply for the Leila Green Alliance of Black School Educators Scholarship. The information contained in this application is true to the best of my knowledge. I understand that any misrepresentation may result in this application being denied If selected, I agree to provide a letter of acceptance from my chosen school in order for funds to be released to selected college or university. I also agree to my name, schools, field of study, and photograph possibly being used to promote the scholarship program. Signature/Date______________________________________________________

Please be sure to submit all of the requested information. ___ 1. This completed application form. ___2. An official transcript of grades. ___3. Two (2) letters of recommendation. ___4. Typed essay of no less than 300 words. ___5. Senior Photo ONLY COMPLETE APPLICATIONS WILL BE CONSIDERED! Return all items in one (1) large envelope by Wednesday, March 22nd, 2017 to: Leila Green (LGABSE) P.O. Box 9564 Canton, Ohio 44711-9564

RETURN TO STUDENT IN SEALED ENVELOPE Leila Green Alliance of Black School Educators School Personnel Recommendation Form

Recommendation For:________________________________________________

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Signature______________________________________Date____________ Name Printed or Typed__________________________________________ Address_______________________________________________________

RETURN TO STUDENT IN SEALED ENVELOPE Leila Green Alliance of Black School Educators Community/Personal Reference Recommendation Form

Recommendation For:________________________________________________

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Signature______________________________________Date____________ Name Printed or Typed__________________________________________ Address_______________________________________________________