Scholarship Nomination Form

Name

First

Last

Address*

Phone*

WHAT UNIVERSITY, COLLEGE OR TRADE SCHOOL DO YOU PLAN TO ATTEND? IF YOU CURRENTLY ATTEND A COMMUNITY COLLEGE, WHAT COLLEGE DO YOU ATTEND?

FIELD OF STUDY

CAREER PLANS AND GOALS

PLEASE PROVIDE US WITH INFORMATION ON WHAT VOLUNTEERISM AND COMMUNITY SERVICE YOU HAVE CONTRIBUTED WITHIN THE SAN FERNANDO VALLEY. (Include sponsoring organization, description of project(s), dates, and hours spent)

COMMUNITY SERVICE REQUIRED BY SCHOOL

COMMUNITY SERVICE AND VOLUNTEER WORK OF YOUR CHOICE

SCHOOL ACTIVITIES

HIGH SCHOOL/COMMUNITY COLLEGE

STUDENT GOVERNMENT (Student body and/or class)

CLUBS AND ORGANIZATIONS

ATHLETICS

ADDITIONAL ACTIVITIES

AWARDS, HONORS AND OTHER ACHIEVEMENTS

OTHER COMMUNITY ACTIVITIES

EMPLOYMENT

RELIGIOUS ACTIVITIES

ADDITIONAL ACTIVITIES

ARE THERE ANY SPECIAL CIRCUMSTANCES THAT SHOULD BE KNOWN TO THE SCHOLARSHIP COMMITTEE WHEN CONSIDERING THIS APPLICATION?

ADDITIONAL COMMENTS

Person Submitting (If different than student)

Name

First

Last

Address

Phone

Email address

This field should be left blank