Ebony R.

Hosey Memorial Academic Scholarship Application

Complete the application and submit all required documentation by May 1, 2019 (postmark
deadline) to:

Ebony R. Hosey Memorial Academic Scholarship

110 Walden Way
Fayetteville, GA 30214

To be considered for a $750 scholarship, you must be:

• A black high school senior planning to enroll full-time in a bachelor’s degree program at
an accredited higher education institution in the summer or fall of 2019 after your high
school graduation
• An East Lansing High School (MI) student with 2-year minimum attendance OR
• A Divine Faith Ministries International (Jonesboro, GA) member with 2-year minimum
attendance
• Have a 2.9 minimum GPA in college preparatory courses

The following documents must be submitted with the application:

• A certified transcript sent directly from your high school(s) to the address above by
May 1, 2019
• A one-page (250 words) essay introducing yourself and detailing an adversity that
you faced and overcame.

Before scholarship funds can be sent to a college or university you must submit:

• The acceptance letter from the accredited four-year institution you will attend
Failure to complete the application and submit all required documentation by the deadline
can result in your application being disallowed for the current application period.

Send questions or inquiries to EbonysScholarship@gmail.com

 Ebony R. Hosey Memorial Academic Scholarship Application

Use black or blue ink. Print or write legibly.

Name_________________________________________________________________________
Last First Middle
PermanentAddress______________________________________________________________
Street
_______________________________ __________________ _________________________
City State Zip Code Home Telephone
______________________________ _____________________________________________
Cell Primary E-mail address

Date of Birth __________________ Year of graduation _________

Month/Day/Year

Colleges Applied To (include city and state) ____________________________________________

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Academic Interest _____________________________________________________________

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

School and Community Activities ________________________________________________

___________________________________________ __________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Work Experience
Job Title Employer City, State Dates Hrs/Wk
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I certify that the information I have provided is true and complete to the best of my knowledge.
If required, I agree to provide proof of this information. I realize that if the required
documents are not provided, I, as the applicant may not be eligible for this scholarship.

___________________________________ ______________________________
Applicant’s Signature Date

By signing this application, you agree that, if you receive a scholarship, the ERHMA
Scholarship may make public use of your name (and that of your parent(s), guardian if
applicable), the amount of the scholarship, the school you will be attending, and a summary of
your qualifications and plans. You must also agree to be contacted by a representative of the
ERHMA Scholarship as appropriate.