Need Based Scholarship

Common Application Form 2015

Scholarships are evaluated with the name of the student removed in order to assure that every applicant is reviewed in a fair and balanced manner.

In addition to this application, you must write a one page, typed personal statement. This statement must be signed by you and attached to this application.

APPLICANT CONTACT INFORMATION

First Name: ______Last Name: ______

Mailing Address: ______City:______

Home phone: ______Mobile phone: ______

Email: ______Date of Birth: ___/___/___

EDUCATION

High School: ______Graduation Date: ___/___/___

SAT Score (if applicable): Critical Reading______Math ______Writing______

ACT Score (if applicable): Composite Score ______

Education institution you plan to attend in Fall 2015: ______

*Please attach a copy of your acceptance letter, if applicable.

Intended major(s) ______

Will you be attending college full time? Yes____ No____

Do you plan to work while in school? Yes____ No____

Where do you plan to live next year? On-campus___ Off-campus___ With Parents___ Other___

What career(s) are you considering? ______

What factors determined your choice of college? ______

______

What do you consider your academic strengths? ______

______

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Applicant Name: ______

BACKGROUND INFORMATION

How many years have you lived in Truckee/Tahoe? ______

Are you a current or former foster youth? Yes _____ No______

Do you live in a single parent household?Yes _____ No______

Are you a single parent? Yes _____ No______

What’s the highest education level achieved by either of your parent(s)/guardian(s)?

Less than 8th grade

Did not graduate from high school

High school graduate

Trade/Vocational Certificate

Associate Degree (AA)

Undergraduate Degree (BS or BA)

Graduate Degree (MS, MA, MD, etc.)

Other ______

Several scholarships we award are specifically designated for immigrant and undocumented students. If you would like to be considered for these scholarships, please answer the questions below. This information will remain confidential.

Are you a foreign born immigrant or first generation immigrant? Yes _____ No______

Are you a U.S. Citizen (born or naturalized)? Yes _____ No______

Are you a permanent resident of the U.S.? Yes _____ No______

Applicant Name: ______

EMPLOYMENT

Beginning with your present or most recent job, list your employment history.

Employer / Position / Dates of Employment / Hours worked per week

What did you do with the money you earned? ______

______

SCHOOL INVOLVEMENT

Please list your top school-related activities in which you have participated.

Activity / Honors and/or Positions held / Dates of Involvement / Hours per month

COMMUNITY INVOLVEMENT

Please list the principal community activities in which you have been involved.

Activity / Honors and/or Positions held / Dates of Involvement / Hours per month

AWARDS AND HONORS

List awards and honors you have received and briefly explain their significance.

Award/Honors / Significance / Date received

Applicant Name: ______

HOUSEHOLD/FINANCIAL INFORMATION

It is strongly recommended that you fill out this section with a parent or guardian. Round all figures to the nearest dollar. Use the most recent income tax information or estimated current year values. Do not leave lines blank.

Name of parent(s)/guardian(s) with whom you reside:

______

If you have filled out the FAFSA (Free Application for Federal Student Aid)

What is your estimated family contribution (EFC) as determined by the FAFSA? ______

If you have not filled out the FAFSA, please fill out this form:

$ / Cost of attending college (include tuition, room and board, transportation, etc.) at college of your choice. If you don’t yet know the college you will be attending, please estimate.
$ / Head(s) of household’s total gross income.
$ / Head(s) of household’s total cash assets (cash, checking/savings account, stocks, home equity).
$ / Student’s income (if not head of household).
$ / Student’s total cash assets (if not head of household).
Number in household your parent(s)/guardian(s) currently support financially including yourself.
Number in household in a college degree/certificate program in 2014-2015 (including yourself)

Please list any grants/scholarships already received for the upcoming academic year:

______

Please describe any special circumstances that may affect your family’s ability to pay for college (medical, divorce, unemployment, child support, other):

______

Applicant Name: ______

REQUIRED SIGNATURES

I certify that the information provided in this application is true and correct. I certify that the financial information provided is complete and accurate. Falsification of information will result in termination of any scholarship granted. I agree to adhere to all of the terms and conditions of my scholarship(s). By signing this application, I formally authorize Tahoe Truckee Community Foundation to seek any information needed to determine suitability for a scholarship award and forever release any entities seeking or providing such information from any and all claims or damages that I may or actually do sustain as a result of seeking or providing such information.

Student’s signature: ______Date: ___/___/___

Parent or Guardian’s signature: ______Date: ___/___/___

This student is in good standing and is on track to graduate in June 2015. The unofficial transcript provides accurate academic information.

School Counselor’s signature: ______Date: ___/___/___

Please select the scholarships for which you would like to be considered. If you are unsure whether you will attend a two or four year school, you may select both.

Pat Sutton Memorial Scholarship for Public Service: $1,000

One year scholarship for a TruckeeHigh School student attending a 4 year school with exemplary community service.

Elenita Sullivan Memorial Scholarship: $8,000

Four year scholarship for a NorthTahoeHigh School student attending a 4 year school in a health related field and who has demonstrated volunteer service($2,000/year for 4 years).

Cameron and Jane Baird Scholarship: $10,000

Four year scholarship for a Truckee or NorthTahoeHigh School Latino/a student attending a 4 year school ($2,500/year for 4 years).

Cameron and Jane Baird Scholarship: $5,000

Two year scholarship for a Truckee or NorthTahoeHigh School Latino/a student attending a 2 year school ($2,500/year for 2 years).

Ed Plaut Jr. Art & Humanities Scholarship: $1,000

One year scholarship for a Truckee or NorthTahoeHigh School student pursuing studiesin the Arts and/or Humanities fields.

Robert “Fro” Frohlich Memorial Scholarship: $500

One year scholarship to a NorthTahoeHigh School student “pursuing your dream”.

Applicant Name: ______

APPLICATION CHECKLIST

Did you remember to:

Indicate which scholarship(s) you are applying for?

Attach your acceptance letter from college, if you have one?

Complete and sign the application form?

Have your parent/guardian AND your school counselor signed the form?

Include an unofficial transcript?

Attach your one page typed personal statement that is SIGNED and DATED?

Deadline for all applications is Wednesday, April 1, 2015 at 5:00pm

Mail: Tahoe Truckee Community Foundation

P.O. Box 366

Truckee, CA96160

Hand delivered:Tahoe Truckee Community Foundation

11071 Donner Pass Road

Truckee, CA96161

RECEIVING A SCHOLARSHIP

We will notify you by Friday, May 1, 2015 if you have received a scholarship. If you receive a scholarship, the following procedures must be followed:

1. You must write a thank you note to:

Stacy Caldwell, CEO

Tahoe Truckee Community Foundation

P.O. Box 366

Truckee, CA 96160

  1. Once enrolled in school, you must obtain official verification of your enrollment from the registrar and submit it to TTCF along with a letter stating where the scholarship check should be mailed. Please send this information to:

Kristi Darzynkiewicz, Financial Officer

Tahoe Truckee Community Foundation

P.O. Box 366

Truckee, CA 96160

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