Author: Suffolk Public Schools
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SCHOLARSHIP APPLICATION

OMEGA PSI PHI, INC.
ALPHA IOTA CHAPTER
P.O. Box 1453
SUFFOLK, VA  23439

The applicant should complete this form with neatness and accuracy and return the form to the Alpha Iota Scholarship Committee, along with a copy of your transcript and two letters of recommendation no later than April 15, 2024. (All information provided will be regarded as Confidential)
A.	 Name of Applicant_____________________________________________________________
                                       		  (Last)                                    (First)                                    (Middle)

Home Address __________________________________________________________________

                            ________________________________________________________________________
                              (City)			(State)		(Zip Code)               (Telephone Number)
	
Place of Birth___________________________ Date of Birth _____________________________

Name of Parent or Guardian ______________________________________________________

B.	School Now Attending:

1.	School _____________________________________________________________________
(Name and Location)

2.	Principal’s Name____________________  Counselor’s Name_________________________

3.	Scholl Telephone Number______________________________

4.	Graduation Date _____________________________________________________________

5.	GPA:___________   ACT Score________  SAT Score________Class Rank _____ of_________

C.	 College, University or Technical school you expect to attend:

1.	College/University or Technical __________________________________________________________________________
(Name and Location)

2.	What area of study have you chosen for your major? ______________________________

3.	 Have you applied?   Yes ______________________ No ____________________________

4.	Have you been accepted?     Yes _______________________ No ______________________

5.	Total projected college expense for the first year___________________________________

D.	Reasons for wanting this scholarship and comment from applicant concerning his qualification for the scholarship.
____________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

E.	Extra-curricular activities including awards, honors, athletics, etc.
____________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

F.	Participation in community organizations and activities
____________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

G.	 Special Talents or Interests
____________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________

H.	Future Educational Plans
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________