Name_________________________________________________________________________________________

Permanent Address:

Street Address ________________________________________ Apt. # ___________________________________

City __________________________________________________ State ___________________________________


Home Telephone _______________________________________ Cell Phone ______________________________

Socal Security Number __________________________________ Date of Birth ________ / _________ / _________

Parent(s) or Guardian(s) Name(s):

First _______________________________ Middle _____________________ Last ___________________________

First _______________________________ Middle _____________________ Last ___________________________

High School ____________________________________________ Counselor _____________________________

Rank in Class _______________ Grade Point Average _______________ Test Scores (ACT/SAT)______/_______

College Major __________________________________________________________________________________

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Scholarship Application
Birmingham Area Tuskegee Alumni Association
Post Office Box 110671
Birmingham, AL 32511
(Please print or type / use black ink.)

State your reason for choosing to attend Tuskegee University

______________________________________________________________________________________________

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Please list honor and extra curricular activities:

High School:

______________________________________________________________________________________________

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Church:

______________________________________________________________________________________________

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Civic/Community:

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Special Aptitudes and Abilities:

______________________________________________________________________________________________

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I affirm that the above information is correct to the best of my knowlede and I will abide by the guidelines established by the Birmingham Area Tuskegee Alumni Association. I further understand that I must maintain good academic standing in accordance with the policies of Tuskegee University for renewal of this award from the Birmingham Area Tuskegee Alumni Association Scholarship Foundation.

Student's Signature ________________________________________ Date ________________________________


Revised 02/03/12