This document is an application for a scholarship award from the Prairie View A&M University National Alumni Association Johnson Space Center Chapter. It requests basic applicant information like name, age, address, parent/guardian details, high school GPA and test scores. It also asks for information on high school and community activities, whether the applicant has applied or been accepted to PVU, and if they were referred by a chapter member. Finally, it prompts a 200-word essay on why the applicant needs or desires the scholarship or wants to attend Prairie View A&M University.

1. Prairie ViewA & MUniversity National Alumni Association
JohnsonSpaceCenter Chapter
P. O. Box 890901 Houston, TX77289
APPLICATION FOR SCHOLARSHIP AWARD
Please complete this form and return to Scholarship Committee at the address above. Application
must be postmarked by April 5, 2013.
1. Name________________________________ Age_____
2. Graduating High School______________________________________________
3. Grade Point Average _______ on 4.0 Scale; SAT/ACT Score ______/______
4. Street Address______________________________________________________
City State Zip
5. Email Address______________________________________________________
6. Telephone_________________________________________________________
Home Mobile Pager Other
7. Male Parent/Guardian_______________________ Occupation_______________
8. Female Parent/Guardian_____________________ Occupation_______________
9. Number of Dependents Residing At Home (including self) _____ Ages_________
10. Number of Dependents in College________________ Ages_________________
11. List high school activities participated in and offices held
12. List activities, offices, honors outside of school (community, church, etc.)
13. Have you applied for admission to Prairie View? ___________________________
Have you been accepted? ___________
14. Were you recommended by a PVU-JSC Chapter Member? Yes ___ No ___
If yes, who recommended you? _________________________________
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2. What is your relationship to the chapter member? _______________
15. Attach a transcript.
Submit a typewritten essay in no less than 200 words. State “Reasons Why I
Need/Desire Johnson Space Center PV Alumni Scholarship” Or “Why I Want to
Attend PrairieViewA & MUniversity.” You may use this space or attach a separate
sheet.
Signature of Applicant ____________________________ Date _______________
Revised 03/13 Page 2 of 2