Scholarship Application 2023 Have you read the Scholarship Program Requirements Yes No The Georgia Haitian American Chamber of Commerce will appoint an independent committee to evaluate applications and select the scholarship recipients. Failure to follow instructions may lead to disqualification of your application. Applicants found to have made false or misleading statements will be disqualified from consideration. If you have NOT done so, take time to read the Scholarship Program requirements. Go to: https://gahcci.org/gahcci-scholarship/1. Name* First Last 2. Mailing Address* Street Address City State / Province / Region ZIP / Postal Code 3. Cell Phone Number*Email Address* 4. Date of Birth* Date Format: MM slash DD slash YYYY Gender*MaleFemaleOther5. Cumulative Grade Point Average (GPA):*(On a 4.0 scale)Attach proof of GPA. Your most recent school transcript is required.*6. Are you of Haitian Heritage*YESNO7. Name and location of High School, College or Nursing School*Note: Applicants for the Lise Tassy Nursing Scholarship Award must have been accepted to, or started the Nursing Program at an accredited Nursing School, ( NOT JUST IN COLLEGE MAJORING IN NURSING).8(A):List any academic honors, awards and membership activities while in high school, and/or college.*8(B): List your hobbies, interests, extracurricular and school-related volunteer activities*8(C): List your non-school sponsored volunteer activities in the community*8(D): Upload their resume and/or activities sheet*8(E): Upload your picture ID*Accepted file types: jpg, png, .9(A). If you have decided on what college/university you will attend, please list the name:*9(B). Include a pdf copy of acceptance Letter*10(A). Career Goal:*10(B). Relevant Internship or Work Experience:*11. Are you or your parent or legal guardian born in Haiti or are of Haitian descent?*YESNOIf your answer is ‘yes’ please answer blocks A, B, C below.12(A): His/her full name:*Full Name12(B): What city in Haiti are you or your parents from?*12(C): What Haitian community or organization are you or your parents a part of?*13. Name & address of parent(s) or legal guardian(s):*(Include address if different than the one listed in Question 2.) Street Address City State / Province / Region ZIP / Postal Code 13(A). Cell phone of parents or legal guardians*13(B). Email address of parents or legal guardians* 14. Personal Essay Questions14(A). How do you identify as someone of Haitian heritage?*14(B). Choose one of the three question below, and answer it.*Answer one of the three questions belowA. How will this scholarship allow you to positively impact the Haitian American community or the world in which you live?B. How do you plan to use your talents and professional skills to contribute to the continued success of the Haitian community?C. What challenges or obstacles have you experienced and overcome in life and how will this help you succeed in college and beyond?Your answer for the question you chose14(C). Why did you choose the nursing career?Applicants for the Lise Tassy Nursing Scholarship Award MUST ANSWER THIS QUESTION.CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.