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Robert R. Church Scholarship Application

In order to apply for a scholarship from the Robert R. Church Scholarship Fund,please complete this application and return it to:

Mid-South Minority Business Council158 Madison Avenue, Suite 300Memphis, TN 38103Attention: Doris Gordon

Applications should be postmarked no later than

April 30, 2009

. Only completeapplications will be considered. If you need more information, call (901) 525-6512, Ext. 613.

Application Information

:Name: __________________________________________________________ Address: ________________________________________________________ Telephone: _______________________________________________________ High School: _________________________ High School Graduation Date: ___ Social Security Number: ________________ Date of Birth: _________________ Are you are high school Senior? ____ Have you applied (__ yes, __ no) and been accepted (__ yes, __ no) forattendance at a degree granting College/University in Tennessee for the fall ofthe upcoming academic year?College/University: _____________________ Anticipated Major: ____________

Personal Information

:Briefly, please describe your educational plans as they relate to your futurecareer goals. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

Robert R. Church Scholarship ApplicationPage Two

Please list all activities (school, work, community) in which you have participatedin high school. Include any special awards, honors or offices held.Activity Years Participated Special Awards, Honors, Offices Held ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Are there any unusual family or personal circumstances that affect your ability topursue your educational goals? If so, please describe. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Please list below the source and amount of any grants or scholarships that youhave been awarded for the coming school year.Name of Grant/Scholarship Amount Granted/Pending ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

*Please review additional sheets attached.

Attachments

:Please include the following materials with the application:1) High school transcript2) ACT/SAT scores3) Three letters of recommendation from teachers, employers, clergyand/or persons other than family members who are familiar withyou and your abilities.4) Copy of parents/guardians 2008 Income Tax Information5) Photo of applicant6) A 500 word typed essay

on “Why I should receive a scholarship”

“What education means to me”

(Essay mustinclude name, address and college or university attending)