DRC Scholarship Application

Personal Information:
Family Name:

First Name:
Postal Address:
Zip/Postal Code:
Email Address:
Phone Number:
Date of Birth:

Level of Educational Training, please check all that apply to you:


Basic School

High School
Name of School:
School Address:
Level Attained:

Vocational School/University/College:
Name of School/University/College:
Institution Address:
Degree(s) Attained:

Names of other educational program(s) you have attended:

School of Application:

Name of Educational Institution:
Institute Telephone Number:
Date of Acceptance:

School year for which applying:
Program of Study:
Annual Tuition Costs:
Book Costs:

Additional information:

Endorsement of Community Leader:

Phone Number:

Email Address:

Please complete this form, print and mail it along with:

  1. A statement of acceptance or registration from the school or university in which you are enrolled.
  2. A statement of support from a Dom (Gypsy) community leader. (Be sure to include this person's name, address and phone number)


Dom Research Center, Inc
PO Box 121
McComb, MS 39649

Please Note:

  • You will be notified if you are selected to receive a Dom Research Center Scholarship.
  • Scholarships will be given directly to the educational institution (no funds will be given to individuals).
  • DRC scholarships are NOT full scholarships. Recipients will be notified of the exact amount of the scholarship.
  • Applications must be submitted by June 30 prior to the academic year for which the scholarship is requested.
  • Students must re-apply each year to receive a DRC Scholarship. The limitations on the number of scholarships any one applicant can receive will be determined by the scholarship administrators.
  • If you receive a scholarship your name, brief information about you and your studies along with a photograph will be keep on file at the Dom Research Center. This information will be used to promote the scholarship fund.


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