rbspapp2 - (This application may be photocopied RETURN TO...

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Ron Brown Scholar Program Application CHECK ONE: I am submitting my application by November 1 st of my senior year in high school in order to be considered for the Ron Brown Scholar Program and to have my application materials forwarded to a select & limited number of additional scholarship providers. I understand that I am still responsible for applying to all scholarship programs for which I am interested. I am submitting my application by January 9th of my senior year in high school in order to be considered for only the Ron Brown Scholar Program. Applicants must be U.S. citizens or permanent residents, Black or African American and current high school seniors at the time of their applica- tion. College students are not eligible to apply. Application materials must be submitted in one packet. Transcripts and letters of recommendation should not be sent under separate cover. SAT/ACT scores must be included on the application at the time it is mailed. Incomplete, e-mailed or faxed applications will not be considered. (This application may be photocopied) RETURN TO: Ron Brown Scholar Program, 1160 Pepsi Place, Suite 206, Charlottesville, VA 22901 PERSONAL DATA (Type or print in black or blue ink only.) Full Legal Name _____________________________________________________________________________________________ Last First Middle Male/Female Permanent Address ___________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ City State Zip ____________________________________________________________________________________________________________ Date of Birth Telephone # Cell # E-Mail Address High School _________________________________________________________________________________________________ Name Street ____________________________________________________________________________________________________________ City State Zip List below your scores and dates you have taken or will take the following (you may submit SAT or ACT): SAT ______ ______ ______ ______ Date V/CR Math Writing ACT ________________________ ________________________ Composite Score/Writing Score/Date
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