Houston Scholarship Form

Contact Info

Individual

Business

First Name*

Last Name*

Email*

Phone *

Ext

Work
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Address Line 1*

Address Line 2

City*

State/Province*

Postal Code*

Country *

Additional Information for Your Scholar(s)

1 X Houston Scholarship Form

Grade*

Date of Birth*

Name of Parent or Guardian*

Parent or Guardian Phone Number*

High School where you attend*

GPA*

Class Rank*

SAT/ACT Test Score*

Major*

Top 3 Strong HBCU Partner Choices? Langston University, Lincoln University, Fisk University, Bennett College, Benedict College - (List in order of main preference) If you list schools that are NOT our HBCU Partners, your application will be deleted. Links to our HBCU Partners websites are listed on the 5 Strong websites.*

Activities/Organizations You're Involved in, In School and out side of school.*

How did you find out about 5 Strong.*

Will you be a first-generation college student?*

I understand if I'm selected I MUST attend ALL bi monthly College Prep Sessions from February - May*

Community Service*

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