Juneteenth Statesville Scholarship

Eligibity

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Student's first name

Student's last name

Date of birth

Month

Day

Year

Address

Phone

High School Name

Graduation Date

Month

Day

Year

College/University/Trade School Accepted To

Intended Major/Program of Study

Proof of Acceptance

Transcript

Letter of Recommendation 1

Letter of Recommendation 2

Letter of Recommendation 3

Resume or List of Activities

In 500–750 words, explain what the IMPACT acronym means to you and how you embody its values in your own life.

Signature

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type full name (first, middle, last)

I certify that all information is accurate and that I meet the eligibility requirements.