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Your first name, middle initial and last name
Your parent or guardian name
Clear Signature
Enter your signature above with your finger, stylus, or mouse. By signing this form, I acknowledge that all information provided by me in this application is true, complete, and accurate.
Date / Time
Clear Signature
Sign only if the student is under 18 years old. By signing this form, I acknowledge that all information provided by the student in this application is true, complete, and accurate.
Date / Time
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Attach your professional jpeg picture file here
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Attach your transcript here in pdf format
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Please scan the letter to pdf format. No phone pictures please

REMEMBER YOUR RECOMMENDATION FORM REQUIREMENT

Remember to ask a teacher or counselor to complete and submit a recommendation form, a requirement for your scholarship application. You can find the recommendation form here.

MANDATORY WORKSHOP

All scholarship recipients must attend a mandatory pre-gala workshop for all scholarship recipients (it will open to applicants as well) on Saturday, January 16, 2027 from 8 am to 12 noon at the Alpha Phi Alpha Fraternity Educational Center at 721 South Walnut, Pine Bluff, Arkansas.