National Association of  
Historically Black Colleges and Universities  
Title III Administrators, Inc. 
www.hbcut3a.org 
 
 
STATEMENT OF ACCURACY 
 
 
Statement of Accuracy 
I hereby affirm that all the above stated information provided by me is true and correct to the best of my 
knowledge. I also consent that my picture may be used for any purpose deemed necessary to promote this 
scholarship program. 
Signature of scholarship applicant:  
 
 
 
 
 
 
 
Date:  
 
 
 
 
 
 
I,  
 
 
 
 
 
 
, certify that I have reviewed the application packet  
 
 
      (Please Type or Print) 
and all items are complete to the best of my knowledge.  
 
Signature of Title III Administrator (Project Director): 
 
 
 
 
 
 
 
 
Date:  
 
 
 
 
 
 
REMEMBER 
• 
The deadline for the application to be received is Friday, September 3, 2021. 
• 
The completed application packet must be emailed to nahbcut3ascholarship@gmail.com.