All requested information MUST be furnished completely. Failure to supply any part of the requested information voids application from consideration. Applications and other required information must be postmarked no later than midnight, May 16th. If mailing a hard copy please return to: 100 Black Men of Jacksonville, Inc., P.O. Box 2065, Jacksonville, Florida 32203
Date Of Birth
Living Accommodations HomeCampus HousingOther
Current Mailing Address
Education & Training
(List last or current college term)
What college or university do you plan on attending this coming year?
Give any information which you feel would be helpful to the Scholarship Committee in assessing your situation and your need for continued financial assistance. (Family financial hardship, medical, unusual circumstances)
Honors and Awards
Offices held in class or college clubs, organizations, etc.
Other College Activities
(i.e. volunteerism, music study, church activities, sports, hobbies, etc.)
Scholarships/Grants (Other than the J100)
Include the academic year the scholarship/grant is applicable and the source of the awarded funds.
Describe any part-time and/or summer jobs while attending school, or full-time employment. Describe significant duties and state average earnings on each assignment.
Enter applicant's current year's earnings:
Parent or Guardian Income Range (Please Check one)
Please list in twenty-five words or less your career goals