First Name:
Last Name:
SSN:
SID:
Address:
City:
State:
Zip:
DOB:
E-mail:
Are you an Arizona Resident?
Yes
No
Do you
have a high school Diploma or GED? Yes
No
High School
GPA
select closest GPA
2.0-2.5
2.5-3.0
3.0-3.5
3.5-4.0
Cumulative College GPA
select closest GPA
2.0-2.5
2.5-3.0
3.0-3.5
3.5-4.0
Cumulative College
Credits completed
Select closest credits completed
under 10
10-15 credits completed
16-20 credits completed
21-25 credits completed
26-30 credits completed
30+ credits completed
Are you
presently employed? Fulltime
Part
time
Work-study
Not employed
Marital
Status:
Married
Unmarried:
Gender:
Male
Female
Do you have
children that you support?
Yes No
Are you
a re-entry student (a student who has had a year or
more break in you education)? Yes
No
Ethnicity:
Caucasian
Hispanic/Latino
African American Asian /Pacific Islander
Native American
Other
Have you performed
Community Service hours in the last year?
Yes
No
If yes,
how many community service hours have you completed
select hours
1-10 hours
11-50 hours
50-100 hours
100-300 hours
What is your
anticipated enrollment for Fall 2008
Full Time (12+ hrs)
Half time (6-11hrs)
Less than half time (<6hrs)
What is your
anticipated enrollment for Spring 2009
Full Time (12+ hrs)
Half time (6-11hrs)
Less than half time (<6hrs)
How many
credits have you completed
at EMCC?
select
1-6
6-12
12-20
20-30
30-40
40+
What is your
anticipated graduation/completion
date at
EMCC ?
select month
May
Summer
December
/
select year
2008
2009
2010
2011
2012
I am seeking a
degree or certificate in
select major
accounting
aeronautics
anthropology
architecture
art
biology
business
chemistry
Computers (any related field)
Criminal Justice
Education (any)
Engineering
foreign languages
general studies
geology
health education and services
humanities
interior design
Journalism
marketing
mathematics
music
Nursing
performing arts
philosophy
Psychology
physical education
physical therapy
Political Science
Pre-Med
recreation
theatre/drama
Real Estate
Social Work
Sociology
Speech
other
if other was selected please specify
Personal
Statement: Please answer the following questions
in the space provided.
(HINT - it is recommended that the applicant
completes the questions in WORD, then copies and
paste the answer into the box.
format/ spell check functions are not
available)
Why are you applying for a scholarship?
What are your educational and career goals, both
short term and long term?
What community service
activities have you participated in?
What challenges have
you overcome in achieving your education?
(financial, personal, medical etc..)
What life
experiences have impacted you the most, and why?
How will you use your educational experience to give
back to your school, community or society?
Student Authorization
Will you authorize MCCCD to use your name, likeness
and biographical material from your
personal statement in promotional materials?
Yes
No
Would you be
able to attend scholarship functions? Yes
No
By
submitting this application, I certify that the
information provided is accurate and correct to the
best of my knowledge.
I f
an award is made, I authorize Estrella Mountain
Community College to release academic, financial
and/or any other necessary information as required
by the donor.
If a scholarship award is made, a letter of thanks
will be required before scholarship funds are
released.
Only hit the submit button once.