Agents of Change

Scholarship Application

First Name^*

Last Name^*

Email^*

Your Address (must be a Brooklyn resident)^*

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Street Number

Street Address

City

State

Country

Zip Code

Apt Number

Phone Number

Date of Birth^*

Current School^*

Current Classification^*

Name of the College/University you will be attending in the Fall of 2019:^*

Fall 2019 Classification^*

Grade Point Average: (GPA):^*

Have you taken the ACT exam?^*

Yes
No

If yes, score?^*

If no, when do you plan to take the exam?^*

Have you taken the SAT exam?^*

Yes
No

If yes, score?^*

If no, when do you plan to take the exam?^*

What major/degree do you plan to obtain as you continue your education?^*

List your academic honors, awards and membership activities:^*

List your community service activities, hobbies, outside interests, and extracurricular activities:^*

Please upload a copy of your acceptance letter.^*

Please upload a copy of you transcript.^*

Please upload proof of enrollment.^*

Please upload a copy of your resume.^*

Please upload a your personal essay.^*

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info@agentsofchangesholars.org

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