The Craig Roberts Memorial Scholarship

Application Deadline: June 30th

Please Return Application to:
Assistant Vice Chancellor for University Advancement
North Carolina A&T State University
Dowdy Administration Building, Suite 400
1601 E. Market St.
Greensboro, NC 27411

APPLICATION

GENERAL INFORMATION
(Please Type or Print)
Social Security No:___-___-___
Date of Birth:___/___/___
Name__________________________________________________________________
Last First Middle Initial
Address_________________________________________________________________
_________________________________________________________________
City State Zip
Telephone Home (____) ____-____ School (____) ____-____
U.S. Citizen Yes___ No___
Ethnic Origin (Optional )
Black ___ Native American___ Hispanic___
White___ Asian/ Pacific Islander___ Other____

ACADEMIC INFORMATION
College/ University_____________________________________________
Name of High School____________________________________________
City State
High School Graduation Date_____ GPA_____ Class Rank_____
Achievement Test Score: _____SAT _____ACT Combined /Composite Score_____
Anticipated Major____________________
Anticipated Graduation Date____________
High School Recommendation From_____________________________________
(Name) (Title)

PERSONAL INFORMATION
(Please list)
1. School-Related Activities:
2. Honors & Achievements:
3. Hobbies, Talents and Special Interests:
4. What is your primary career goal?
5. What is the highest degree level you would like to obtain?
Degree____________ Discipline______________

ESSAY
In 250 words or less, typewritten, please explain how the Craig Robert Memorial Scholarship will make a difference in your ability to be academically and professionally successful.

Financial Aid Information
If you are considered a dependent student, please indicate the approximate income of your family.
_$10,000 or less _$30,000 -$40,000
_$10,000- $20,000 _$40,000- $50,000
_$20,000- $30,000 _$50,000 or more
Do you anticipate receiving a (check all that apply)?
_Pell Grant _College Work Study
_ National Direct Student Loan (NDSL) _State Scholarship
_ Guardian Student Loan (GSL) _Other Merit/ Campus
_State Student Incentive Scholarship
Parents’ Occupation/ Education:
Mother_________________ Education (circle one) High School 1 2 3 4
College 1 2 3 4      Master’s _        Ph.D. _
Father___________________ Education (circle one) High School 1 2 3 4
College 1 2 3 4      Master’s _        Ph.D. _
Do you have any brothers or sisters in college? If so, please give institution, academic level and major?

LETTER OF RECOMMENDATION
Recommendation for _________________________________
High School ________________________________________
(Attach additional sheets if necessary)
Name/ Title __________________________________________
Address _____________________________________________
Telephone ___________________________________________
Signature ____________________________________________
Please return by June 30th to the
Assistant Vice Chancellor for University Advancement
North Carolina A&T State University
Dowdy Administration Building, Suite 400
1601 E. Market St.
Greensboro, NC 27411

FOR OFFICE USE ONLY
CLASS RANK______
SAT/ ACT____/____
GPA____________
MAJOR__________
DATE RECEIVED——-