District of Columbia State Organization Scholarship Application Deadline March 15, 2019
SUBMIT BY MARCH 31ST Send one completed copy of this form to the Chairperson of the Nu State Scholarship Committee. I. PERSONAL DATA Name_______________________________________________________ Address______________________________________________________ _____________________________________________________________ Telephone_________________(home) _________________(cell) Present Employment Status____( ) Employed ( ) Retired Present Educational Assignment (if employed) Name of Institution ______________________________________________ Address _______________________________________________________ _______________________________________________________________
II. DELTA GAMMA ACTIVITIES Member of _______________________ Chapter Date of Initiation ______ Society Experience: (office, chairmanship, workshops, committee work) Chapter Level: State Level: Regional Level: International Level:
III. EDUCATIONAL PREPARATION: Provide names of institution, dates of attendance, degree (s) received.
IV. PROFESSIONAL EXPERIENCE Provide name of institution, title of position, type of work, date in position.
V. OTHER RELEVANT EXPERIENCES: Include travel, exchange program, seminars, special training.
VI. SPECIAL HONORS:
VII. MEMBERSHIP IN PROFESSIONAL, CIVIC, AND COMMUNITY ORGANIZATIONS: Indicate offices held/leadership roles.
VIII. SCHOLARSHIPGRANT ELIGIBILITY: Purpose of scholarship/grant ( ) Graduate Study-Indicate level/institution___________________________ ( ) Educational Research ( ) Purposeful Study/Travel Previous DKG Awards/Scholarship- indicate date (s)
IX. PROPOSED USE OF SCHOLARSHIP/GRANT: Provide a detailed statement of proposed program of study, research, or study/travel. Indicate future value of DKG membership and the community. Attach additional sheets, if necessary.
X. BUDGET: Itemize how budget will be used. ( Attach additional sheet if necessary.)
XI. Applicant will have Chapter Scholarship Chairperson certify application. I certify that the above name applicant is/has been a member in good standing of ___________________ Chapter of Nu State at least two years prior to the date of this application. ________________________________ Signature of Chapter Scholarship Chairperson
XII. Mail completed application by MARCH 31ST, 2019 to: MS. VERNITA JEFFERSON 712 STIRLING ROAD SILVER SPRING, MD 20901