Tahoe Truckee Community Foundation Need Based …



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Need Based Scholarship

Common Application Form 2016

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. Please address intended majors, activities, etc. relevant to specific scholarships for which you are applying. This statement must be signed by you and included with this application.

APPLICANT CONTACT INFORMATION

First Name: ______________________________ Last Name: _________________________________

Mailing Address: ______________________________________________________________________

City:__________________________________________ State:________________ Zip:_____________

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 2016: _________________________________________

*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? ____________________________________________

____________________________________________________________________________________

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 (required)

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 2015-2016 (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 2016. 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 Truckee High School student attending a 4 year school with exemplary community service.

( Elenita Sullivan Memorial Scholarship: $8,000

Four year scholarship for a North Tahoe High 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 North Tahoe High 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 North Tahoe High 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 North Tahoe High School student pursuing studies in the Arts and/or Humanities fields.

( Robert “Fro” Frohlich Memorial Scholarship: $500 each for two scholarships

One year scholarship to a North Tahoe High School student “pursuing your dream”.

(Continued on next page)

Applicant Name: ______________________________________________________________________

( Jackson Ferree Scholarship to honor students who march to the beat of their own drummer: $40,000

Four year scholarship for a TTUSD high school student with independence of spirit and demonstrable kindness ($10,000/year for 4 years).

□ Tahoe Donner Giving Fund Scholarships: $2,000 each for two scholarships

One year scholarship for a TTUSD graduating senior to attend an approved technical, vocational, 2 or 4 year school. A 3.0 GPA preferred.

□ 2016 Steingard & Blumenstock Scholarship for the Arts: $1,000

One year scholarship for a TTUSD student pursuing higher education in an art related major at either a two or four year school.

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? (Only 1 transcript required if applying for multiple scholarships)

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

NOTE:

• Do NOT use staples

• If applying for multiple TTCF scholarships, only one transcript and one copy of acceptance letter(s) is necessary to be submitted with your application package.

Deadline for all applications is Friday, April 1, 2016 at 5:00pm

Mail: Tahoe Truckee Community Foundation

P.O. Box 366

Truckee, CA 96160

Hand delivered: Tahoe Truckee Community Foundation

11071 Donner Pass Road

Truckee, CA 96161

RECEIVING A SCHOLARSHIP

We will notify you by Friday, April 29th, 2016 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

Once enrolled in school, you must obtain official verification of your enrollment from the registrar and submit it to the Tahoe Truckee Community Scholarship Committee (not TTCF) along with a letter stating where the scholarship check should be mailed. Please send this information to:

Tahoe Truckee Community Scholarship Committee

ATTN: Lisa Melin

11603 Donner Pass Road

Truckee, CA 96161

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