You are on page 1of 4


Eligibility Criteria

• must be a current member of a South Carolina TRiO Program
• must be nominated by his/her TRiO Program director or authorized designee
• must be in pursuit of a high school diploma or bachelor degree (Two-year transfer programs
are eligible)
• must demonstrate academic achievement and leadership through high school and/or college
• must have a minimum of 3.00 cumulative GPA on a 4.00 scale at end of Fall semester (an
unofficial copy of your transcript (s) must accompany your application (Exception,
EOC Participants)
• must be currently enrolled in a secondary or post-secondary institution as a full-time or part-
time student (Exception, EOC Participants)
• must have your application emailed on or before March 17, 2017

General Instructions
Please type or print the application in black ink. This is a merit-based scholarship. Therefore,
successful candidates must submit supporting documentation to attest to their significant
accomplishments. Academic excellence, extra curricula activities, community and civic
involvement, etc. are factors considered in the awarding of this scholarship.

Completed applications must include:
1. An unofficial high school/college transcript.
2. Two references that should be emailed directly to the Scholarship Chair (one from an
teacher/instructor/professor or counselor and one from an organization advisor or
community/civic leader who can attest to your community and civic involvement)
3. An essay that describes how receiving this scholarship will assist you in your academic and
career goals

c/o Tara Holmon
email to :

Section I: Personal Information

Last Name ______________________________ First Name _______________________ MI _____
Street Address ____________________________________________________________________
City __________________________________ State ______ Zip Code _______________________
Daytime Phone ____________ Evening Phone ____________ E-mail ________________________
Date of Birth ____________________

Program affiliation: ETS UB UB M/S SSS EOC

Section II: Demographical Information
College/School Enrolled _________________________ Projected Graduation Date: ____________
Street Address_____________________________________________________________________
City _____________________________________ State _________ Zip Code _________________
College Major: _________________________________ Career Goal: ________________________

Section III: Essay
You must submit an essay no less than 250 words and no more than 400 words in support of your
scholarship application. The essay should address how your involvement with Educational Talent
Search, Upward Bound, Upward Bound Math/Science, Student Support Services or the
Educational Opportunity Center program has contributed to the achievement of your academic and
careert goals presently and how being awarded this scholarship will assist you in the near future. The
essay should be typed and double spaced using a 12-pitch font. Essay should be sumbitted via email
to Tara Holmon at (

Section IV: Honors, Awards and Community Service
List academic and/or non-academic honors and awards you have received while enrolled in high
school and/or college. (Exception, EOC Participants cover the last five years). Addendums can be
submitted if desired (This section must still be completed).

Honor/Award Issued By Date Received
1. _________________________ ______________________ ____________
2. _________________________ ______________________ ____________
3. _________________________ ______________________ ____________
4. _________________________ ______________________ ____________
5. _________________________ ______________________ ____________
6. _________________________ ______________________ ____________

Community and Civic involvement and Extracurricular Activities
List service projects, volunteer work or other activities in which you demonstrated leadership while
enrolled in high school and college (Exception, EOC Participants cover the last five years).
Addendums can be submitted if desired (This section must still be completed). Please include any
community service in which you may have been involved.

Name of Activity/Service Date (s) of Participation Office Held
1. _________________________ ________________ __________________________
2. _________________________ ________________ __________________________
3. _________________________ ________________ __________________________
4. _________________________ ________________ __________________________
5. _________________________ ________________ __________________________
6. _________________________ ________________ __________________________

TRiO Activities and Awards
List any TRiO activities you have participated in or awards you have received. (Do not duplicate
information from previous sections)

Name of Activity/Service Your Role in Activity Date (s)
1. _________________________ ______________________ ____________
2. _________________________ ______________________ ____________
3. _________________________ ______________________ ____________
4. _________________________ ______________________ ____________
5. _________________________ ______________________ ____________
6. _________________________ ______________________ ____________

Section V: Applicant’s Certification and Signature
___ I certify that the information provided on this application is true and correct to the best of my
___ I understand that completion of this application does not guarantee scholarship funds.

Signature of Applicant: _____________________________________ Date: __________________

Section VI: Program Information and Certification
Name of Institution/Agency and TRiO Project: ____________________________________________
Director: __________________________ Mailing Address: _________________________________
City ______________________________ State ______ Zip Code __________Phone___________
E-mail ________________________________
Nominator: ______________________________________
Office Phone _____________________________ E-mail _________________________________
Position/Title: _____________________________________________________________________

Statements of certification/understanding: Read and place a check mark in front of statement.

___ I certify that I am a Professional/Associate member of SC TRIO and that my membership
is in good financial standing.
___ I certify that my program sponsored participant (s) at the 2017 Wanda-Hendricks
Bellamy Student Leadership Conference this year.
___ I certify that the applicant is a participant in a TRiO program hosted by my
___ I understand that applications must be emailed by due date.
___ I understand that applications arriving late and/or incomplete will not be considered for
___ I understand that each TRiO Project may nominate one student for the SC TRIO General

SC TRiO Nominator’s Signature _____________________________________ Date ________

Application Check list
___ All Required Signatures And Dates
___ Transcript(s) Exception, EOC Participants
___ Reference Forms (2)
___ Essay (no less than 250 words and no more than 400 words)
___ Application Is Completely Filled Out