Robert R.

Church Scholarship Application

In order to apply for a scholarship from the Robert R. Church Scholarship Fund,
please complete this application and return it to:

Mid-South Minority Business Council

158 Madison Avenue, Suite 300
Memphis, TN 38103
Attention: Doris Gordon

Applications should be postmarked no later than April 30, 2009. Only complete
applications will be considered. If you need more information, call (901) 525-
6512, Ext. 613.

Application Information:

Name: __________________________________________________________

Address: ________________________________________________________

Telephone: _______________________________________________________

High School: _________________________ High School Graduation Date: ___

Social Security Number: ________________ Date of Birth: _________________

Are you are high school Senior? ____

Have you applied (__ yes, __ no) and been accepted (__ yes, __ no) for
attendance at a degree granting College/University in Tennessee for the fall of
the upcoming academic year?

College/University: _____________________ Anticipated Major: ____________

Personal Information:

Briefly, please describe your educational plans as they relate to your future
career goals.
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Robert R. Church Scholarship Application
Page Two

Please list all activities (school, work, community) in which you have participated
in high school. Include any special awards, honors or offices held.

Activity Years Participated Special Awards, Honors, Offices Held

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Are there any unusual family or personal circumstances that affect your ability to
pursue your educational goals? If so, please describe.
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Please list below the source and amount of any grants or scholarships that you
have been awarded for the coming school year.

Name of Grant/Scholarship Amount Granted/Pending

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*Please review additional sheets attached.

Attachments:

Please include the following materials with the application:

1) High school transcript

2) ACT/SAT scores
3) Three letters of recommendation from teachers, employers, clergy
and/or persons other than family members who are familiar with
you and your abilities.
4) Copy of parents/guardians 2008 Income Tax Information
5) Photo of applicant
6) A 500 word typed essay on “Why I should receive a
scholarship” or “What education means to me” (Essay must
include name, address and college or university attending)
 Requirements for Robert R. Church Scholarship

Listed below are the eligibility requirements for potential scholarship

candidates:

• Must provide a 500 word typed essay on “Why I should receive a

scholarship” or “What education means to me” (Essay must
include name, address and college or university attending)

• Must be a Memphis City or Shelby County Public School Student

• Must maintain a “C” average in junior and senior year of school

• Must be a high school senior

• Must attend a 2 or 4 year College/University in the State of Tennessee

• Must major in a Business Related Field

• Must provide proof of financial need – Parents/Guardians 2008

• Income Tax Information

• Must provide a photo of applicant

Note:

• Students that meet the eligibility requirements will be interviewed by the

Robert R. Church selection committee