2025 BVG Scholarship -1st Year – 100 Black Men of Jacksonville, Inc.

All requested information MUST be furnished completely. Failure to supply any part of the requested information voids the application from consideration. Applications and other required information must be submitted no later than midnight, May 31, 2025.

I. Applicant's Information

Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Best Contact Phone #

Applicant's Email

Email

Confirm Email

Date of Birth

Place of Birth

Race / Origin

Gender

II. Family Information

Do you have a Mother, Father or Guardian in your life?

Yes
No

Do you have...

Father/Guardian
Mother/Guardian

Who do you live with?

One Parent/Guardian
Two Parents/Guardians

Who do you live with? (copy)

Relatives
Other

Number of brothers

Number of sisters

Age of brother(s)

Age of sister(s)

Father Or Legal Guardian Name

First

Last

Father/Guardian's Age

Father/Guardian's Address

Address Line 1

Address Line 2

City

State

Zip Code

Father/Guardian's Occupation

Father or Legal Guardian Education

Father/Guardian's Phone

Father/Guardian's Email

Check here if the father or legal guardian is a 100 chapter member

Yes

Name & number of J100 chapter member?

Mother Or Legal Guardian Name

First

Last

Mother/Guardian's Age

Mother/Guardian's Address

Address Line 1

Address Line 2

City

State

Zip Code

Mother/Guardian's Occupation

Mother or Legal Guardian Education

Mother/Guardian's Phone

Mother/Guardian's Email

III. Education & Training

High School Name

High School Phone

High School Address

Address Line 1

Address Line 2

City

State

Zip Code

Expected Graduation Date

1st Choice - what School or college do you plan to attend this year?

2nd Choice - what School or college do you plan to attend?

3rd Choice - what School or college do you plan to attend?

What is your planned major?

Describe briefly your plans and your future vocational or professional objectives. Give any information that you feel will be helpful to the committee in assessing your situation and your need for financial assistance.

Attach a complete transcript of the applicant’s educational history from grade 9 up to, and including, the first semester of grade 12. Also accompanying this transcript should be college entrance exams scores (SAT, ACT, PERT).

Click or drag files to this area to upload. You can upload up to 5 files.

IV. School Activities

List them below. If you have none, enter 'None'.

Honors and Awards

List all scholarships or grants received, grades 9-12.

Offices held in class or school clubs, organizations, etc.

List each, a description, and number of years of involvement.

Non-school activities

List church participation, hobbies, special talents, community services, etc.

Scholarships or Grants

Other than 100 Black Men of Jacksonville, Inc., list other agencies and organizations + amounts.

V. Work Experience

Describe your work experience (part time, full time, and/or vocation jobs).

List the job, your title, description, hours per week, and dates of employment.