Last Name______

Dream Keeper Scholarship Program

NEW Applicants

Application Deadline: May 1, 2017

Personal Information

Name

Home Address

City, State, Zip Code

School Address, if different
City, State, Zip code
Home Phone: Cell Phone Email
Date of Birth SSN

Racial/Ethnic Information

______American Indian or Alaskan _____ Asian or Pacific Islander _____ African American ______Hispanic

______Caucasian ______Multi-Racial______Other (Specify)______

Academic Information

Name of High School Graduated From______

City/State______Graduation Date/Year______GPA______

SAT Score: Critical Reading ______Mathematics ______Writing______ACT Score______

I am currently enrolled in college Yes ____No____

If yes, Name of School ______Number of credits earned to date______

In the fall of 2013, I will be a: Freshman ______Sophomore______Junior ______Senior______

If no, in the fall, I plan to enroll in a: 4-year college_____ Junior College _____Other_____

Name of school I hope to attend______Have you been accepted? Yes___No__

COLLEGE APPLICATIONS

Please indicate all colleges you applied to?

NameLocationAccepted (Y/N)

SCHOLARSHIP APPLICATIONS

Please indicate all colleges you applied to?

NameAward Amount

Hannah Project Participation (15 Points)

Are you currently enrolled as a Hannah Project Student? Yes____ No_____

If no, have you ever been enrolled in the Hannah Project? Yes____ No_____

How long was your involvement? _____

What was the nature of your involvement? How regularly have you participated______

Check all that apply.

College Tour

Cash for College

Saturday School

SAT Review Course

College Bound Brotherhood

Student Volunteer

Tutoring

Summer Academic Camp

College Conversations

Other ______

Has your parent participated in Hannah Project activities? Yes____ No_____

If yes, describe what activities.

  1. KNOWLEDGE OF HANNAH PROJECT (5 Points)

Based on your involvement or knowledge of the Hannah Project, what are Hannah Project/Dream Keeper Scholarship values and principles and how do you feel you are/will exemplify them in your future endeavors?

B.EMPLOYMENT/AWARDS/ACTIVITIES (10 Points)
1.Please describe any extracurricular, community service, or outside activities (clubs, sports, or volunteer work) in which you have participated recently. Please describe your role and any leadership you may have provided?
2.Please tell us about any special honors, recognitions or awards you have recently received.
  1. CAREER PLANS (10 Points)
  1. What are your short and long-term career objectives? What are you or do you plan to major in? Why?
  1. COMMUNITY IMPACT (10 Points)
  1. How will you use your college education to improve your community and/or address a major societal issue?
  1. PERSONAL STATEMENT (40 POINTS)

Please attach the following

  1. A personal statement of 500 words or less on a separate paper answering the question: What is special, unique, distinctive, and/or impressive about you or your life story? In addition to your innate characteristics, what skills or talents do you want to acquire to ensure your success? (You may use essay that was submitted as part of your college application)
  2. A short essay of 350 words or more that responds to the following question: What book, art piece, music, or historical figure has influenced your thinking or values and why?
  1. HANNAH SERVICE REQUIREMENT (5 POINTS)

If awarded a scholarship, all recipients are required to fulfill 10 hours of community service for the Hannah Project over the course of a year. How do you plan to fulfill the Hannah Project community service requirement? Explain which of the tasks below are you most interested in volunteering in and the tentative time frame in which you wish to perform the service.

Host a Hannah Project Tour of Your College

Tutor a Hannah Project Student or other Marin City students

Volunteer to work at Saturday School

Write an article for the Newsletter

Help with the Graduation Ceremony or other Hannah events

Represent the Hannah Project at an Information Booth

Give talk to other students

Other, explain.

  1. TRANSCRIPTS/ HIGH SCHOOL RECORD AND SAT/ACT SCORES (20 Point)

School transcripts and test scores will be factored into the evaluation of your scholarship application.

Parent Information

Parent 1Name: Graduated high school ______

Address: ______Attended college ______

Phone: ______Email: ______Graduated college ______

Attended graduate school______

Degree earned______

Parent 2Name: ______Graduated high school ______

Address: ______Attended college ______

Phone: ______Email: ______Graduated college ______

Attended graduate school______

Degree earned______

Legal GuardianName______

Address______

Phone (____) ______Email ______

Family Income

Please attach a copy of the completed FASFA you submitted for the 2009-2010 school year.

How many people are in your family? ____ How many of them are dependent children? ___

What is your approximate total family income per year?

 Under $20,000 Between $21,000 - $40,000

 Between $41,000 - $60,000 Between $61,000 - $80,000

 Between $81,000 - $100,000  Over $100,000

Other information about your family income or circumstances that we should consider in making an award recommendation:

Expenses and Financial Assistance

How much will it cost you to attend college?

  1. Tuition:
  2. Housing:
  3. Food:
  4. Books:
  5. Travel:
  6. Other:

Total Costs:______

What financial support will you have?

  1. Savings/ Parents/Gifts :
  2. Scholarships (Total):(List all scholarships anticipated below)
  1. Pell Grant
  2. Cal Grant
  3. School Award
  4. Student Loans:
  5. Parental Loan :
  6. Work/Study:
  7. Summer Employment :
  8. Other Resources

Total Contribution: ______

Spring 2017 Dream Keeper Scholarship Award Application –NewPage 1

Last Name______

Difference/Balance: ______ (Subtract “total contribution” from “total costs”)

What is your Estimated Family Contribution (From FASFA)______

Comments: Explain any extraordinary circumstances that may influence your financial picture for the 2009-10 school year or special financial need you may have.

Please attach a copy of your 2016 SAR Report and a copy of the award letter from the college that you expect to attend. Feel free to provide any additional information that you believe would be helpful to the Scholarship Committee in assessing your personal or financial need.

Other -Attachments

The following items must be attached to this application in order for the application to qualify to be reviewed by the scholarship committee. Circle Yes or No to be sure you have attached each required item:

Yes NoMost recent official high school or official college transcript.

Yes NoProof of ACT or SAT scores

Yes NoCompleted Reference Form. Attached completed forms in a sealed envelope.

Yes NoCopy of SAR report including 2016 EFC.

Certification

I, the undersigned, certify that all of the information I have included in and with my application is true. I understand that if I am selected for an award, I may be required to submit further proof of my acceptance to or enrollment in an accredited college, community college, university or recognized trade school. Further, I understand that official verification will be required of my attained grades and test scores. I understand that if I am selected for an award, official verification will be required of my completion of the course(s) on which the award is based. I agree that if I am selected for an award, my name, photograph, and/or essay may be used for publicity purposes with no additional compensation by the sponsors of this scholarship program. I also certify that I have read and understand the information above.

I further certify that my application is complete and that I have included the following:

Signature______Date______

REMEMBER: The Deadline for the scholarship application to be received by the Hannah Project is:

Monday: May 1,2017 11:59 pm

Submit all completed applications to:

The Hannah Project

441Drake Avenue, Marin City 94965

For questions: Please contact

Spring 2017 Dream Keeper Scholarship Award Application –NewPage 1