P.O.

Box 1102 Flint, MI 48501

2018 Urban League of Flint Black Scholars All Stars

Scholarship Application
1. Scholar Full Name: __________________________________________________________________
2. Scholar’s Parent(s)/Guardian’s Name: ___________________________________________________
3. Address: ___________________________________________________________________________
4. City/State: _____________________________________________ Postal Code: ________________
5. Home Phone: __________________________________ Cell Phone: ___________________________
6. High School: _______________________________________________________________________
7. Grade Point Average: _________________________________________________________________
8. ACT Scores: ________________________________________________________________________
English ____
Math _____
Reading ____
Science _____
Composite ____

9. Please list any honors, awards and/or scholarships you have been awarded:
___________________________________________________________________________________

10. Please list your extra-curricular and/or community service experiences:

___________________________________________________________________________________

11. College Attending/Major: _____________________________________________________________

12. Household Size

___ 1-3
___4-6
___7-9
13. What is your approximate household income:
___ $0 - $24,999
___$25,000 - $49,999
___$50,000 - $74,999
___$ 75,000 - $99,999
___$100,000 - $124,999
___$125,000 - $149,999
___$150,000 - $174,999
___$175,000 - $199,999
___$200,000 – and up
___ Prefer not to disclose household income

14. Please briefly describe your intended major and future goals:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

IF APPLYING FOR AN URBAN LEAGUE OR SPONSOR SCHOLARSHIP, COMPLETE A 500-WORD

ESSAY ON “WHAT WOULD BE YOUR SOCIAL AND EDUCATIONAL RESPONSE TO THE FLINT
WATER CRISIS”? Please type your essay on a separate sheet of paper.