United Belizeans of Northern Illinois

2015 Scholarship Application

Application must be received by June 1st, 2015 by 5:00 p.m. Application must be accompanied by all 7 requirements.
Incomplete application will not be accepted and no applications will be accepted after that date.

____________________________

_____________________________

Applicants Name

Applicants Address

Application Checklist:

Scholarship Application: All sections of this application must be completed. The students must sign and
date the last page of this application. Application Deadline is June 1st, 2015. No applications will be
accepted after that date.

Essay: Must be 500 words typed, double space, Times New Roman, size 12. Please choose one topic
1. What experiences have prepared you to excel academically?
2. What are the most important forces that motivate you as a student?
3. Why is cultural identity important to you?

Transcripts: Submit an official High School or college transcript with GPA indicating your most recent
academic work.

Letter Of Recommendation: The student must submit (1) letter of recommendation

Release of Consent Form
Acceptance Letter from College or University

Photograph

Who is Eligible? Students are eligible to be considered for $500.00 UBNI Scholarship if
they:
* Are of Belizean Descent and be 24 years of age or younger
* Are residents of Illinois
* Enrolled at least 6 credit hours at a local community college or University
* Have attained a cumulative grade point average of 3.0 or higher on a 4.0 scale
* Have demonstrated leadership abilities through participation in community service,
extracurricular, or other activities.
* Have completed and submitted all required forms
* All finalists must be present for an interview with members of the UBNI Scholarship
committee board.
* Attend UBNI Gala on August 8 to receive Award
* Application Deadline is June 1st, 2015.
* Scholarship is non-renewable
Please submit all materials to:
United Belizeans of Northern Illinois
Attn. Scholarship Committee
P.O. Box 1036
Waukegan, Illinois 60079

Questions?? Post on FB or Contact Julietberni1027@gmail.com or annaluna2003@yahoo.com

United Belizeans of Northern Illinois

2015 Scholarship Application
Application must be received by June 1st, 2015 by 5:00 p.m. Application must be accompanied by all 7 requirements.
Incomplete application will not be accepted and no applications will be accepted after that date.

Personal Information:
First Name

Middle Name or Initial

Last Name

_____________________________________________________________
Address

__________________________ ________
City

State

_______________________

Zip

Telephone

______________________________________________________________________________________
Email Address
Date of Birth:________/________/________

Gender: Male______ Female______

Parent(s) or Guardian with whom you live:

Name__________________________________Relationship_____________________________________
Name__________________________________Relationship_____________________________________

Academic Background
Name of Your Current High School_________________________________________________________

________________________________________________________________________
City

State

Expected Graduation Date:_________

Grade Point Average:_________

Zip

Class Rank:_______________ out of_________________

ACT Score (Composite)________

SAT Score ________

College/ University or Trade School you plan to attend in fall of 2015:_____________________________

______________________________________________________________________________________
City
State
Zip
Circle one:

2-year Institution

4-year Institution

__________________________________________________________________________________
Major
Career Goals
________________________________
Signature of Applicant

_______________
Date

Questions?? Post on FB or Contact Julietberni1027@gmail.com or annaluna2003@yahoo.com

United Belizeans of Northern Illinois

2015 Scholarship Application
Application must be received by June 1st, 2015 by 5:00 p.m. Application must be accompanied by all 7 requirements.
Incomplete application will not be accepted and no applications will be accepted after that date.

Consent of Release Form

Photo/Video Release

I, ______________________________________give my consent to_____________________________________ to

( name of parent/guardian if applicant is minor )
( name of applicant)
be videotaped, photograph, audio taped, and/or interviewed for United Belizeans of Northern Illinois, for the
purposes of publicity, advertising, or media coverage related to the activities of the United Belizeans of Northern
Illinois scholarship program. I understand that social medias will be utilized to promote the mission of UBNI.
Parent/ Guardian Signature ______________________________________Date ___________________

Questions?? Post on FB or Contact Julietberni1027@gmail.com or annaluna2003@yahoo.com