W.E.B. Du Bois Society - High School Students

To learn more about you as an individual, we would like you to take some time and thought to complete this one question. Please complete your answer in your own words.

* Essay Question: African American students trail their counterparts in academic achievement across every achievement measure: high school graduation rates, math and reading proficiency rates, college enrollment rates, and college graduation rates. Many factors contribute to this challenging reality. What can young people do, if anything, to address this problem? What specifically are you willing to do as a Du Bois Scholar in The WEB?

Please limit your essay to 200 words or less. Word Count:

About the parents/guardians...

Parent/Guardian 1

* Parent/Guardian Name:

* Relationship:

* E-mail:

* Home Phone:

* Cell Phone:

* Work Phone:

Fax:

* Company:

Permanent Home Address:

* Address:

* City:

* State:

* Zip:

Company Business Address:

* Address:

* City:

* State:

* Zip:

Parent/Guardian 2

* Parent/Guardian Name:

* Relationship:

* E-mail:

* Home Phone:

* Cell Phone:

* Work Phone:

Fax:

* Company:

Permanent Home Address:

* Address:

* City:

* State:

* Zip:

Company Business Address:

* Address:

* City:

* State:

* Zip:

REQUEST FOR FEE WAIVER
Completing the following statement constitutes the digital signature of the parent/guardian.

I request a waiver of the $75 application fee required to complete my registration to the W.E.B. Du Bois Society. I certify that my household income is $50,000 or less and have sent a copy of our W-2 to W.E.B. Du Bois Society, P.O. Box 723154, Atlanta 31139 along with your completed application by February 13, 2010. Download PDF of fee waiver here.

I grant my permission to photograph/videotape/interview my son/daughter for promotional and educational purposes.

* I am sending a copy of report cards for the past three years (rising freshman only) or an official transcript and a copy of the most recent CRCT test score. Send to the W. E. B. Du Bois Society, P.O. Box 723154, Atlanta 31139 prior to the final application due date of February 13, 2010.

* I have informed my Teacher Recommender that I am applying to The WEB, and have asked him/her to complete the online Recommendation Form.
Online Recommendation Form

* My parent/guardian has read and signed the online parent information and consent form.
Parent Information and Consent Form

I grant my permission to photograph/videotape/interview my son/daughter for promotional and educational purposes.

Your application is not complete until payment has been received.

* I have informed my Teacher Recommender that I am applying to The WEB, and have asked him/her to complete the online Recommendation Form.
Online Recommendation Form

* My parent/guardian has read and signed the online parent information and consent form.
Parent Information and Consent Form

STUDENT Application