Santa Ana College Application for 2007 – 2008 Scholarships

DeaDline to apply is March 6, 2007

v Fill out this form completely and attach all requested documents. Turn in three (3) copies of a completed application with


v If you decline to answer a question or turn in an incomplete application, you may not be considered for certain scholarships

that require the missing information.

v If you do not turn in three (3) copies of a completed application you may not be considered for all scholarships.

Please submit your application in the following order:

Ì Application form – cover page through page 7

Ì Autobiographical Statement

Ì Letter(s) of Recommendation – page 8

Ì Financial Information

All three (3) copies must be in the order listed above.

v Number your applications #1, #2, & #3 in the upper left corner of this page.

The Scholarship Program office is available to preview your application prior to submission. Please make an appointment in S-204 or

call the Scholarship Program at (714) 564-6478.

Please place a check mark next to the scholarships that meet the minimum criteria for your student profile.

q Academic Senate Thomas Hartnett Memorial

Scholarship for Academic Excellence

q Academic Senate Continuing Student Scholarship

q Academic Senate Student Leadership Scholarship

q Academic Senate Hawa Sankoh Memorial

Science Scholarship

q Academic Senate Beverly Goldstein Scholarship

q Academic Senate Victor Rivera Memorial Scholarship

q Grace Alberts Memorial Scholarship

q Kevin Arrabaca PTK Scholarship

q Francisco Bertot Memorial Scholarship

q Mirrle W. Bouchey English Major Scholarship

q Susan & John Brenner Memorial Scholarship

q Carl W. Bull Nursing Scholarship

q Ellyn Bye Scholarship

q California Retired Teachers Association Scholarship

q “CASA” Cuban American Scholarship Association

q Catalina Scholarship

q Chancellor’s Ball Scholarship

q Cesar Chavez Scholarship

q Chemistry Department Scholarship

q Ming T. Cheng Memorial Nursing Scholarship

q Terry Lee Coleman Memorial Scholarship

q Maud J. Conrow Scholarship

q Mariah Daniel-Platt Memorial Scholarship

q Irene Daniger Memorial Scholarship

q Joan Dowden Memorial Nursing Scholarship

q Lois and Hobert Drewry Memorial Scholarship

q Sky Dunlap Journalism Scholarship

q EOPS / CARE Scholarship

q Allan & Sandy Fainbarg Scholarship

q Margaret Fellows Memorial Scholarship

q Patricia Pett Ferazzi / Robert Ferazzi Scholarship

q Robert Fierro Scholarship

q Lee Ford Memorial Scholarship

q Friends of the College Scholarship

q Friends of the Leisure World Library,

Seal Beach Scholarship

q Junko Fuji Memorial Scholarship

q Gemini Club Scholarship

q Genesis Science or Engineering Scholarship

q Genesis Continuing Student Scholarship

q Allen W. Goddard Memorial Scholarship

q Hector G. Godinez Scholarship

q Glenn L. Harper Memorial Scholarship

q James Harris Scholarship

q Barbara Hartman Early Childhood Educator

Award Scholarship

q Art Hayes Memorial Chemistry Scholarship

q Kathleen Heffley Scholarship

q Dorothy & C. Norman Hicks Trust Scholarship

q Frederick J. Hills Memorial Scholarship

q Human Services Scholarship

q Genevieve Humiston Memorial Scholarship

q International Student Academic Scholarship

q International Student Service Scholarship

q Gene Isaacson Memorial Scholarship

q Phyllis P. Jamison Memorial Scholarship

q Lyle Probert Johnson Memorial Scholarship

q Ashraf Kashi Memorial Scholarship

q Mehdi Kashi Memorial Scholarship

q Zein Kashi Memorial Scholarship

q Phyllis Laranjo Memorial Business

Applications Scholarship

q Zena Gladys Leck Memorial Scholarship

q Literature Matters Scholarship

q Ann Lonsdale Memorial Scholarship

q Patricia Marin Memorial Scholarship

q Robert McCarry Memorial Scholarship

q Lyod & Helen McMillan Scholarship

q Beatrice B. McKowan Honor Scholarship

q Lillian Soto Nahoum Memorial Scholarship

q Edward M. Nealley Scholarship

q Newtown Realtors Scholarship

q Don Nichols & Georgia Summers Honors Program


q Eleanor Northcross Memorial Scholarship, P.E.O.

Chapter AB

q Michael Obermeier Memorial Television Video


q OCTFCU Worthy Student Award Scholarship

q Thomas & Ginger Osborne Future Teachers Scholarship

q Outstanding Chemistry Student of the Year Scholarship

q Puente Project Scholarship

q Alberto Radillo Scholarship

q Anastasia Sadler Memorial Nursing Scholarship

q Santa Ana 2000 Transfer Student Scholarship

q Santa Ana College Dance Award & Scholarship

q Santa Ana/Tustin Soroptimist International:

Bethany J. Ochal & Rosemary Curtis Scholarship

q John Shaffer Smith Music Scholarship

q Linda I. Smith Foundation Scholarship

q Randall G. Smith Memorial Scholarship

q Myrna Sorensen Memorial Scholarship

q Town & Country Manor Nursing Scholarship

q Milan Uverity Memorial Endowment in

Music Scholarship

q Valencia Family Scholarship

q Bret Van Tatenhove Memorial Scholarship

q Jose Vargas & RFG Bankers Scholarship

q Waltmar Foundation Scholarship

q Women in Science, Engineering and

Math Club Scholarship

q Women Who Count Scholarship

q Women’s Academic Scholarship

q Women’s Helen S. Fierman Memorial Effort Scholarship

q Women’s Shirley Ralston Leadership Scholarship


Please select all educational goals that pertain to you.

(Example: x Biology x Medical x Pre-Med x Science)

Course of Study:

____ Anthropology

_____ Art

_____ Biology

_____ Broadcast Journalism

_____ Business Administration

_____ Business Majors

_____ Chemistry

_____ Communication

_____ Computer Science

_____ Counseling

_____ Criminal Justice

_____ Dance

_____ Education Majors

_____ Engineering

_____ English

_____ Fine & Performing Arts


_____ Foreign Language Majors

_____ Human Development

_____ Human Services

_____ Humanities

_____ Japanese

_____ Journalism

_____ Law

_____ Liberal Arts

_____ Library Technology

_____ Mathematics

_____ Medical

_____ Music

_____ Nursing Majors

_____ Nursing Program

_____ Physics

_____ Political Science

_____ Pre-Med

_____ Psychology

_____ Public Affairs

_____ Science Majors

_____ Social Science

_____ Social Work

_____ Sociology

_____ Spanish

_____ Speech Communications

_____ Television-video

_____ Theater Arts

_____ Vocational Majors

__________________________________________ p3

Last Name, First Name

Santa Ana College Scholarship Application

Scholarships for the 2007 – 2008 Academic Year

Deadline to turn in the Scholarship application is: March 6, 2007


(Last Name) (First Name) (MI)


(Street Address) (City) (Zip)


(Phone Number) (Date of Birth) (Age) (Student Number)


(Message Number - Optional) (Email Address - Optional)

Gender: Male [ ] Female [ ] Marital Status: Single [ ] Married [ ]


List College Major ___________________________________________________________________________________

List Educational Goal: ________________________________________________________________________________

(Examples of educational goals: Teacher, Counselor, Architect, Doctor, Accountant, etc.)

Select only one:

_____ In the fall 2007 I will attend Santa Ana College

_____ In the fall 2007 I will attend a four-year college or university.

List the name of the college(s) that you will attend or have applied to:

Unit Eligibility:

Fall 2006

______ Number of units completed in the fall 2006 at Santa Ana College.

______ Number of units completed in the fall 2006 at another college.

Spring 2007

______ Number of units’ in-progress for the spring 2007 at Santa Ana College.

______ Number of units’ in-progress for the spring 2007 at another college.


______ Total completed units from all colleges as of March 6, 2007.

__________________________________________ p4

Last Name, First Name

Course Completion:

_____ Business Application completion of 9 or more units

_____ Chemistry 219 & 229 completion with a letter grade “B”

(Chemistry 229 may be in progress)

_____ Chemistry 249 & 259 completion

(Chemistry 259 may be in progress)

_____ English 101 completion with a letter grade “A”

_____ English 101, 102 and an English Survey of Literature class completion

_____ English 200 level completion of at least two classes: List classes: _____________________________________________

_____ ESL completion: List last class completed: ____________________________________________________________

_____ Honors Program enrollment: List last class(es) completed: _________________________________________________

_____ Puente Project enrollment, past or present: List semester of last enrollment _____________________________________

_____ Speech class to improve communication skills

(Not Speech 101, ex: Speech N50, N51, N52, N53, N55, etc.): List last class completed ______________________________


_____ Have dependent children under 15 years of age.

_____ Bilingual language skill: List language _______________________________________________________________

_____ Graduation from a High School in the Santa Ana Unified School District: List High School: ___________________________

_____ Farm worker / son or daughter of a farm worker

_____ Pursuing a career in Education (teaching)

_____ Pursuing a career in Counseling in an educational setting

_____ Pursuing a career in Social Services

_____ Pursuing a career in the Performing Arts: List field ______________________________________________________

_____ Community involvement through church related activities

_____ Staff member of El Don and/or West 17th

_____ Employee of SHURFLO or a relative of a SHURFLO employee

_____ Past or present Santa Ana 2000 Scholarship recipient

_____ Currently receiving services from EOPS/CARE

_____ Currently receiving services from the Disabled Students Program and Services (DSPS)

_____ Currently receiving Financial Aid

_____ Currently receiving services from State Aid Agency

_____ Student in the International Student Program with a letter of recommendation from a staff member in

the International Student Program

_____ Student Government involvement (ASG) as an officer: List office held _________________________________________

_____ Currently Involvement in Student Clubs as an officer: List club(s) __________________________________________

List office held________________________________________

Year _______________________________________________

_____ Currently Involvement in Student Honors Society: List society __________________________________________

List office held________________________________________

Year _______________________________________________

_____ Involvement in Transfer Programs: List program(s) _______________________________________


_____ AB540 Student

_____ F1 Visa Student in the SAC International Student Program (student record must show F1 status)

_____ Permanent Resident

_____ U.S. Citizen

_____ Other

_____ Decline

__________________________________________ p5

Last Name, First Name

Ethnicity: Ethnicity can be described in many different ways. Please select the ethnic description that best describes you for

consideration in this scholarship competition. The donors have provided these descriptions. You may be considered under more than

one group. If you do not provide your ethnicity you may not be considered for all scholarships.

_____ African American

_____ Asian

_____ Chicano/a

_____ Cuban

List who in your line of decent was born in Cuba (parent, grandparent or great grandparent) ________________________

_____ Hispanic

_____ Latino/a

_____ Mexican-American

_____ Minority

_____ Vietnamese

_____ Other:_____________________________________________________________

School Activities:

(List any SAC Club, ASG, or Athletic Program and any office held over the last two years.)

(ASG) Officer /Year (CLUBS) Officer/Year


Community / Church Activities:

(List any community or church organization that you participate in. List position held and length of service.)


(List current employment: Company name – job title – length of employment – how many hours per week.)

__________________________________________ p6

Last Name, First Name


Students who wish to apply for and be considered for scholarships that require financial information must supply Federal Income Tax

information. A copy of the first two pages of your 2005 Federal Income tax form “1040” or “1040” EZ Must be attached. You must also

attach the first two pages of your parent’s 2005 Federal Income tax form “1040” if you are claimed as a dependent. If you are over 23 years

old, or are not claimed as a dependent you may submit only your income tax forms. The Scholarship Program is unable to accept State

Income tax forms, W2 forms or payroll check stubs to meet the financial information criteria. Students who decline to provide

financial information will not be considered for need based scholarships.

Select Only One:

I am an independent student.

Independent students are not claimed as a dependent on the “1040” Federal Income Tax form. Students 24 years of

age or older are considered independent.

_____ I have attached a copy of my 2005 “1040” Federal Income Tax form.

I am a dependent student.

Dependent students are claimed as a dependent on parent’s “1040” Federal Income Tax form. Most students 23 years

old and younger are considered dependent.

_____ I have attached a copy of my (student’s) 2005 “1040” Income Tax form


_____ a copy of my parent’s 2005 “1040” Income Tax form.

I am an International Student with an F1 VISA.

International Students in the International Student Program are not required to supply Federal Income Tax


_____ I am an International Student and understand that I will not be considered for financial need

based scholarships.


Students may decline to provide financial information. If so, please select the option below.

_____ I do not wish to supply financial information.


The “other” category is for students who do not fit any of the above categories. If you do not have Federal Income Tax

information to provide you may complete the “Financial Information Alternate” form in lieu of the “1040” Federal

Income Tax form.

_____ I select the “other” category and have completed the “Financial Information Alternate” form.


Complete only if you have no other forms to provide financial information.

This alternate form is to report income for students’ whose parents do not file income tax forms and/or AB540 students.

Be sure to include yourself in the count of children and total size of family. Attach supporting documentation if available.

Attachments are not required but may be helpful to the reader.

1. Family Information

Number of adults: _________

Number of children: _________

Total size of family: ___________

2. Annual income: _________

Remarks: (optional)

__________________________________________ p7

Last Name, First Name


Your statement is very important. The Scholarship Committee uses the statement to learn more about you as an individual and to understand

your experiences, accomplishments and points of view. This statement gives you an opportunity to discuss attributes and experiences that

may not be evident through a review of your academic records. Write a statement about yourself on separate paper using no more than

two sheets of paper. Below is a list of items that you might consider covering in your statement.

1. Discuss your interest in your intended major, how your interest in the field developed stating your educational and career goals.

2. Provide information about your family and work experience. List any unusual family or personal circumstances of special


3. Provide information about your school and your involvement in community service.

4. State why it is important for you to receive a scholarship. How will a scholarship help you complete your educational goal?

5. Elaborate on any “qualifying statement” you have made. (For example, if you select the qualifying statement that you have a

career goal to be a teacher, include that information in your statement.)

Special Circumstance: (Please check on the line below to be considered)

_____ I feel that I have a special hardship (family, personal, financial or other) that I wish the scholarship committee to consider.

I have written about my situation in my autobiograhical statement.


For assistance with your application contact the Scholarship Program in S204 at (714) 564-6478.


I hereby certify that the information contained herein is true and accurate to the best of my knowledge and I authorize the

Scholarship Committee to review my official transcript(s) and all other data pertaining to this application. I also authorize the

Scholarship Program office to review, use and release my application information with academic records to scholarship donors.

I acknowledge that all the information provided is given freely and may be used by the donors to determine eligibility.

(WITHOUT your signature we are unable to obtain your transcript and process your application.)


(Applicant’s Signature) (Date)

(Initial) _____ I understand that recipients are expected to attend the Scholarship and Awards Ceremony.

It is a condition of receiving scholarships. Any recipient who is unable to attend must contact the

Scholarship Program office to make alternate arrangements.

(Initial) _____ All recipient information will be posted on the Scholarship Program bulletin board. The official

notification list will be posted for May 1, 2007.

(Initial) _____ During the competition, no part of your application will be returned to you.


Name: __________________________________________________ Student Number: ______________________________



Fill in your name and student I.D. number and give this form to a Santa Ana College faculty member, counselor or someone familiar

with your qualifications. The form should be returned with your scholarship application package.

The above named candidate is applying for a scholarship at Santa Ana College. The Scholarship Committee finds candid, thorough evaluation

invaluable in the decision-making process. Please include any information on the candidate that you feel is pertinent. Your prompt appraisal

will help to assure full consideration. This two part recommendation form must be turned in with the student’s scholarship application. Please

be sure to give the recommendation form with letter to the student ASAP. Due to the limited staffing in the Scholarship Program office we will be

unable to supply copies of recommendations during the competition.

I. Please rate the applicant in each of the following categories:


II. Please describe the qualities, which you believe make this applicant a desirable candidate for a scholarship.

Please attach a separate sheet of paper. Do not write on the back of this sheet.


Evaluator Name: (Print) Signature / Date


Position / Department / Phone #

Santa Ana College Scholarship Office

1530 W. 17th Street

Santa Ana, CA 92706

(714) 564-6478

NoTe: The Scholarship Program office is unable to accept Letters of Recommondation past the deadline. There will be no exceptions.