Scholarship – Confidential Form #2 – 100 Black Men of Jacksonville, Inc.

(Counselor, Dean, or Principal)

MUST be submitted no later than midnight, May 31, 2025.

Name of Scholarship Applicant (must match their application)

First

Last

To be completed by someone having knowledge of family’s financial situation:

Counselor
Dean
Principal

G.P.A.

Rank in class

Out of...

Concerning the above named applicant.

Please furnish whatever information you have which might be useful to the Scholarship Committee.

The Committee would appreciate brief, specific comments on such matters as the following:

1. The nature and extent of your acquaintance with the applicant;

2. Your impression of his or her character and personality;

3. And any knowledge you may have of his or her family’s financial circumstances.

Financial Comments

Counselor's Information

First

Last

Counselor's Address

Address Line 1

Address Line 2

City

State

Zip Code

Counselor's Phone #

Dean's Information

First

Last

Dean's Address

Address Line 1

Address Line 2

City

State

Zip Code

Dean's Phone #

Principal's Information

First

Last

Principal's Address

Address Line 1

Address Line 2

City

State

Zip Code

Principal's Phone #

*** J100 Notes (to be completed by J100 scholarship committee) ***