Scholarship Form - Udoka Women's Association

Personal Information

Last Name*

First Name*

Middle Name

Gender*

Date of Birth*

Nationality*

Permanent Address Number*

Permanent Street Address*

City*

State*

Zip Code*

Telephone Number*

E-mail Address*

Emergency Contact

Emergency Contact Name*

Relationship*

Address*

Telephone Number*

E-mail Address*

High School Information

High School Attended*

Grade Point Average (Cumulative)*

Proposed College / Course of Study

Candidate Profile

Full Name*

Contact Address*

Phone Number*

Email*

Parents / Guardian*

High School Attended* (Candidate Section)

University / College Attending*

Course of Study*

Interests*

Future Goal(s)*

Photography Consent Form / Release

I hereby grant permission to Udoka Women’s Association of Southern California to take photographs and/or digital images of me for use in news releases and/or educational materials. I further agree that my name and identity may be revealed in descriptive text or commentary in connection with the image(s). I authorize the use of these images without compensation to me.

Granting Permission (Full Name)*

Date*

Name of Adult Subject*

Address*

City*

State*

Zip*

Release for Minor Children (Under 18)

Name of Parent/Guardian

Name of Child

Date

Full Name of Parent or Guardian

Address

City

State

Zip

Required Documents

Admission Letter*

Please attach a copy of your Admission Letter on the School Letterhead (PDF/DOC)

Official Transcript*

Please attach a copy of your official Transcript (PDF/DOC)

Applicant Photo*

Please attach a copy of applicant's photo (JPG/PNG)

USA Scholarship Application Form

Scholarship Application Form