Application Deadline:

April 27, 2017

Phi Beta Sigma Fraternity, Inc.

ZETA PI SIGMA ALUMNI CHAPTER

GAMMA EPSILON GAMMA CHAPTER

ALAIN LeROY LOCKE SCHOLARSHIP

BROTHERHOOD, SCHOLARSHIP, AND

SERVICE

PLEASE PRINT CLEARLY or TYPE ALL INFORMATION. The essay should be thoughtfully and clearly
written, but succinct. The application will be rated on appearance, verifiability of information,
clarity, and evidence of achievement. Incomplete applications will not be considered.
 Phi Beta Sigma Fraternity, Inc.
HONOLULU SIGMAS
A.L. LOCKE SCHOLARSHIP
BROTHERHOOD, SCHOLARSHIP, AND SERVICE

APPLICATION REQUIREMENTS

The Zeta Pi Sigma Alumni Chapter and Gamma Epsilon Gamma Collegiate Chapter of Phi Beta Sigma
Fraternity, Inc., scholarship committee will award several scholarships to deserving high school seniors
preparing to enter a two or four-year college/university. Applications will be reviewed and judged on the
basis of academic record, community service, extracurricular activities, and essay submission.

Who can apply?

Any high school senior who has applied and been accepted into a two or four-year college or university
that is recognized by the major accrediting organizations for U.S. colleges, universities, and higher
education institutes. If you receive an appointment to a United States Service Academy or a full
scholarship to a four-year university, you will not be eligible to receive the A. L. Locke Scholarship.

What can students do with the money?

Students can use their scholarship money on any school related activity they choose in order to continue
to pursue their goals or dreams. Examples include books, supplies, and activity fees.

How to apply?

Students applying for the A. L. Locke Scholarship must complete and submit:

1. Application form;

2. Official High School transcript verifying G.P.A. (sealed and certified by Registrar);

3. Two letters of recommendation - One (1) from your community, and one (1) from an

Academic source (on letterhead);

4. An acceptance letter from the college / university you have chosen to attend;

5. A personal essay;

All completed packages must be post marked no later than April 27, 2017 to the address below, or
submitted to your high school counselor's office no later than the above date. Application forms can be
obtained at your high school's counselor's office or via www.alohasigmas.org website.

* All applicants must be accepted as an undergraduate (5 year programs acceptable).

** No applicant can be immediate relative of a member of The Zeta Pi Sigma Chapter or Gamma Epsilon
Gamma Chapter of Phi Beta Sigma Fraternity Inc.

*** It is the policy of Phi Beta Sigma Fraternity Inc., Zeta Pi Sigma and Gamma Epsilon Gamma Chapter
not to discriminate on the basis of race, color, religion, gender, national origin, age, or disability in its
programs or employment practices as required by Title VI and VII of the Civil Rights Act of 1964, Title IX
of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age
Discrimination Act of 1975 and Title II of the Americans with Disabilities Act of 1990.
 Phi Beta Sigma Fraternity, Inc.
HONOLULU SIGMAS
A.L. LOCKE SCHOLARSHIP
BROTHERHOOD, SCHOLARSHIP, AND SERVICE
PERSONAL INFORMATION

NAME _________________________________________________________________________
LAST FIRST MIDDLE

HOME ADDRESS____________________________________________________________

____________________________________________________________

____________________________________________________________

TELEPHONE NUMBER(S)_____________________________________________________

STUDENT EMAIL ADDRESS___________________________________________________

DATE OF BIRTH ____________________________________________________________

HIGH SCHOOL INFORMATION

SCHOOL CURRENTLY ATTENDING__________________________________________________

SCHOOL ADDRESS_______________________________________________________________

(Must be filled out by Senior Guidance Counselor)

G.P.A: ______ CLASS RANK: ______ Graduation Date: ___________

I verify that the student listed above is a high school senior in good standing and that the
school academic information provided is accurate to the best of my knowledge.

Guidance Counselors name/Signature: ___________________________________ Date: __________

List any Academic Honors or Achievements received during high school.

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

List any School Activities, Organizations, or Leadership Positions held during high school. Include dates of
 Phi Beta Sigma Fraternity, Inc.
HONOLULU SIGMAS
A.L. LOCKE SCHOLARSHIP
BROTHERHOOD, SCHOLARSHIP, AND SERVICE
participation.
_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

List any Community Activities outside of school. Include any positions that you held.

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

List the names of Colleges or Universities which you have been accepted, in order of preference.

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

I certify that the information cited herein, and which I authorize you to verify is true and correct to the
best of my knowledge.

________________________________________Signature of Applicant
The information supplied by the applicant will be held in the strictest confidence and will be shared only
with those persons directly involved with the scholarship selection process.

ESSAY QUESTION
On an attached typed document, write an ESSAY (500-750 words) Describe solutions you would propose
to improve or resolve a current issue, such as health care, the economy, discrimination, global warming
or a current event topic of your choice.

APPLICATION SUBMISSION

Point of Contact:
Charles Mason
Chairman, Education Committee
Phone: (253)376-0762
Email: Sigma.zetapisigma@gmail.com

Mailing Address:
 Phi Beta Sigma Fraternity, Inc.
HONOLULU SIGMAS
A.L. LOCKE SCHOLARSHIP
BROTHERHOOD, SCHOLARSHIP, AND SERVICE
Phi Beta Sigma Fraternity Inc.
Zeta Pi Sigma Alumni Chapter
Education Committee Chairman
P.O. Box 30572
Honolulu, Hawaii 96820

Complete Application Postmark no later than April 27, 2017

Notification of Award: No Later Than May 26, 2017

We understand that our signature and submission of this application authorizes the scholarship
committee of the Zeta Pi Sigma Alumni Chapter and Gamma Epsilon Gamma Collegiate Chapter
of Phi Beta Sigma Fraternity, Inc., to obtain verification of information provided. We also give
permission to release information for publicity to the national, regional and local chapter's
websites or publications of Phi Beta Sigma Fraternity Inc.

Signature of Applicant_____________________________________ Date_____________________

Signature of Parent/Guardian_______________________________ Date_____________________

SCHOLARSHIP COMMITTEE USE ONLY

Date Received: ______________________ Date Reviewed: ___________________

Date Notified: _______________________ Date Scholarship Issued: ______________