Black Cultural Center

Sankofa Scholar Program Application

Name*
First Last
Preferred Name
I identify my gender as
Race/Ethnicity(Check all that apply)
- Asian/Pacific Islander
- Black/African American
- Hispanic/Latino
- Native American/Alaskan Native
- White (Non-Hispanic)
- Two or More Races
Date of Birth*
Hometown- City/State
Academic Year*
Phone Number
Email*
CPO Number
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Prospective Major*
Hobbies/Interests*
T-Shirt Size*
Please list any known food allergies