California Student Opportunity and Access Program Los Angeles Consortium Fall 2015 High School Scholarship Application

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1 California Student Opportunity and Access Program Los Angeles Consortium Fall 2015 High School Scholarship Application The California Student Opportunity and Access Program (Cal-SOAP), Los Angeles Consortium was initiated in Our mission is to provide support to underrepresented students, parents and the community in order to increase participation and academic access in post-secondary education. The Cal-SOAP program is designed to help increase postsecondary educational opportunities as well as to disseminate information on financial aid opportunities to low-income, first generation students. As a senior you are about to complete a necessary step on your way to becoming a college student. The scholarships awarded are intended to assist students with the cost of college tuition and fees. To be eligible for the scholarship students must: 1) Be a Cal-SOAP participant 2) Be a graduating High School senior attending college in the Fall of ) Demonstrate Financial Need 4) Must complete a Release Consent Form if scholarship is awarded 5) Must sign a pledge to keep in contact with Cal-SOAP Los Angeles Consortium, and seek and enroll if eligible in support programs at the college/university you will be attending (i.e., EOP, PUENTE, Adelante) if scholarship is awarded In order for the application to be considered all of the following items must be submitted to the Cal-SOAP representative or college counselor at your high school by Wednesday March 25, (No or faxes of the application packet will be accepted): Part 1: Part 2: Part 3: Part 4: Part 5: Part 6: Part 7: Part 8: Part 9: Application Form (completed and signed) Copy of Unofficial HS Transcript with weighted GPA Cal Grant GPA Verification Form (included in this application packet) Student Aid Report (SAR) - Report is generated when the student completes a FAFSA (Free Application for Federal Student Aid). *AB 540 Students/Dreamers must provide a Dream Application Confirmation Page (page is generated when the student completes a Dream Application) and Dream Act Student Aid Report. Proof of Income Resume Cal-SOAP Activity Description Form (included in this application packet) Personal Statement ( words, double spaced and typed) Two Cal-SOAP Recommendation Forms (included in this application packet) All required documents must be turned in as a complete packet (use one staple on the top left-hand corner to submit the documents in the order above) to your Cal-SOAP representative or college counselor at your high school. Incomplete applications will automatically be disqualified. All application requirements are subject to verification. If you have any questions regarding the scholarship, please contact the Cal-SOAP representative or college counselor at your high school. Awardees will only be notified by . Note: Once recipients have been selected and conditionally offered an award, they will be required to submit additional forms that will be requested in the award letter. Failure to submit all required forms will result in rescission of the scholarship award. Funds will be distributed directly to the Financial Aid Office/Scholarship Office of the college or university the student attends. Students must attend an accredited degree-granting 2 or 4 year institution (community college or four year university/college) to receive the scholarship. If a student is attending a community college, s/he must be in an Associate s degree or transfer program.

2 Part 1: Application Form California Student Opportunity and Access Program Los Angeles Consortium Fall 2015 High School Scholarship Application Please use only black or blue ink 1. Name 2. Date of Birth: / / First Middle Last 3. Home Address Number Street Apartment # City State Zip Code 4. Cell Phone #: ( ) - 5. Secondary Phone #: ( ) - 6. Gender (circle one): Male or Female 7. Address: 8. Check below if applicable: First-Generation (You are considered first-generation if your parents have not received an Associates, Bachelors, Masters and/or Doctorate Degree) 9. Ethnicity (select one): 10. Race (if not Hispanic or Latino, select one or more): Hispanic or Latino Not Hispanic or Latino American Indian or Alaskan Native Black or African American White 10. A.) If applicable (check one): Asian or Native Hawaiian or Other Pacific Islander Mark all that apply: Chinese Laotian Guamanian Japanese Cambodian Samoan Korean Filipino Tahitian Vietnamese Hmong Other Asian Indian Hawaiian 11. High School attending: 12. High School Graduation Year: 13. HS Current weighted GPA (obtain from transcript): 14. Colleges Applied to: 1) 2) 3) 15. Mark Yes or No for each question: Do you qualify for the free or reduced lunch program? Are you an AB540 student? Single parent household? Are you currently or were a foster youth? Yes No I certify that the information contained in this application is true and acknowledge that any information contained therein is subject to verification by Cal-SOAP staff and if found not to be true will disqualify me from the scholarship process. Also, by signing this form I grant Cal-SOAP permission to utilize my image/name and/or that of my child who is named on this form for program marketing and promotional related materials. If the student is of adult age, a parent or guardian will not need to sign and the student s signature grants Cal-SOAP permission to use their image/name for marketing and/or promotional materials. Student s Signature Date Parent s/guardian s Signature Date

3 Part 2: Unofficial Transcript Please submit a copy of your unofficial transcript (it does not have to be sealed) clearly showing all courses taken since the 9 th grade up to the current grade with weighted GPA (academic, weighted high school GPA). Note: Attach your HS transcript behind the Application Form (Part 1). Part 3: Cal Grant GPA Verification for the Cal-SOAP Scholarship Dear School Official, Please take a few minutes to fill out the following information which will be used by Cal-SOAP in the selection of scholarship recipients. The calculated GPA should include all completed academic coursework excluding courses such as PE, ROTC, Service or any other non academic courses. The GPA requested is the same GPA required by the California Student Aid Commission on the Cal Grant GPA Verification Form. Student Name: H.S. Attending: H.S. Address: H.S. Cal Grant GPA: School Official Signature: Title: Date: Part 4: Student Aid Report or Dream Act Student Aid Report Please submit Student Aid Report (SAR) - Report is generated when the student completes a FAFSA (Free Application for Federal Student Aid). Download and print summary from the fafsa.ed.gov website. You must submit all pages. *AB 540 Students/Dreamers due to non-residential status will not need to file a FAFSA because they are not eligible for federal student aid. Instead, they must submit a Dream Application Confirmation Page (page is generated when the student completes a Dream Application) and a Dream Act Student Aid Report. Download and print summary from the dream.csac.ca.gov website. You must submit all pages. Note: Attach your Student Aid Report behind this sheet.

4 Part 5: Proof of Income The first two pages of your parent(s) /guardian(s) 2014 income tax forms (i.e., Form: 1040, 1040 A, or 1040 EZ), which include tax payer s adjusted gross income, number of exemptions, and signatures. If your parent(s)/guardian(s) did not file, please submit a notarized letter (from a Notary Public) which must include: your (student s) name, the amount of people living in the household, the amount your parent(s)/guardian(s) earned for 2014, and their signatures. Part 6: Resume Note: Attach the Proof of Income and Resume behind your Student Aid Report. Part 7: Cal-SOAP Activity Description Form Please refer to the Cal-SOAP Activity Description Form attached. Note: Attach the Cal-SOAP Activity Description Form behind your Resume. Part 8: Personal Statement Please submit a typed written word essay addressing the following questions: What influenced you to pursue a college education and how will this scholarship help you achieve those goals? Feel free to discuss any personal achievements, special circumstances and any other information that would help you distinguish yourself from other applicants. Please use double space and 12-point font to type your essay. Your essay should be identified with your name and labeled Personal Statement on the top of the first page. Note: Attach your Personal Statement behind the Cal-SOAP Activity Description Form. Part 9: Two Cal-SOAP Recommendation Forms Please provide two (2) Cal-SOAP Recommendation Forms (obtain from this packet), print each form separately, one from a teacher and the other from a school official. Recommendation Forms are not to be submitted in envelopes and/or be sealed. Please advise those who will provide you with a recommendation form that letters or forms other than the ones provided in this application packet will not be considered. Note: Attach the Two Cal-SOAP Recommendation Forms (2 sheets) behind your Personal Statement.

5 Part 7: Cal-SOAP Activity Description Form Cal-SOAP Activity Description Form Please list and briefly describe your activities from 9 th through 12 th grade, make sure to indicate any leadership positions and any Cal-SOAP sponsored activities in which you participated. Please use only black or blue ink. Mark the grade level you received HONORS & AWARDS: award/honor Name (list name of award & reason for receiving it) Activity: Describe any activity or community service you participated in or outside of school Mark the grade level you participated in activity Name (include any positions held) Hours/Week Weeks/Year Special Programs Activity: List special program activity you participated in or out of school Mark the grade level you participated in activity Name (i.e., Cal-SOAP CSULA campus tour every year) Hours/Week Weeks/Year

6 The student must turn in a recommendation form from a teacher and may only use this form. (Recommendation letters or forms other than this one will not be considered) Teacher s Name Signature School Teacher s phone/ How long have you known this student & in what context? Please use only black or blue ink Cal-SOAP Recommendation Form What are the first words that come to your mind when describing this student? Do you believe this student is deserving of this scholarship (please provide an explanation)? Yes No Ratings: compared to other students in his/her class year, how do you rate this student in terms of: No basis Criteria Academic achievement Below (above Very (Well above Outstanding (top 5%) One of the top few I ve encountered (top 1%) Extracurricular accomplishments Personal qualities and character Initiative/motivation Emotional maturity Integrity Leadership/influence Evaluation: Please write whatever you think is important about this student, including a description of academic, extracurricular, and personal characteristics on the area provided below (additional letters will not be considered).

7 The student must turn in a recommendation form from a school official and may only use this form. (Recommendation letters or forms other than this one will not be considered) Name & Title of school official Signature School School official s phone/ How long have you known this student & in what context? Please use only black or blue ink Cal-SOAP Recommendation Form What are the first words that come to your mind when describing this student? Do you believe this student is deserving of this scholarship (please provide an explanation)? Yes No Ratings: compared to other students in his/her class year, how do you rate this student in terms of: No basis Criteria Academic achievement Below (above Very (Well above Outstanding (top 5%) One of the top few I ve encountered (top 1%) Extracurricular accomplishments Personal qualities and character Initiative/motivation Emotional maturity Integrity Leadership/influence Evaluation: Please write whatever you think is important about this student, including a description of academic, extracurricular, and personal characteristics on the area provided below (additional letters will not be considered).

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