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1、Counselor:_2008 2009_ High SchoolStockton Unified School DistrictGeneral Scholarship ApplicationAll information MUST be typed. Go to www.stockton.k12.ca.us and save to document file and you will be able to type application.Name: (Last) (First) (Middle)Student ID Number:E-mail Address:Insert a pictur
2、e of yourself here.Date of Birth:Place of Birth:Home Address:Home Phone:Cell Phone:Race/National Origin:Educational InformationFathers Name: Occupation: Employer:School:Mothers Name: Occupation: Employer:(Weighted)Total G.P.A.:Total number of people living in home including parents:Rank in Class:Num
3、ber of Dependent brothers & sisters living in home:UC/CSU G.P.A.:Number of Dependent brothers attending college:Number of Dependent sisters attending college:College Major:Does your family contribute to their financial support? (Please explain)1st Choice College:2nd Choice College:I am planning a ca
4、reer as:SAT: _What degree do you plan to obtain? AA BA/BS MA Ph.D.ACT: _Deadline to Counselor: Friday, January 16, 2009Deadline to Student Services on Scholarship Due DateRevised August 2, 2008Name: _ Date: _List your parents memberships in professional or work related organizations:List your parent
5、s membership in service and civic organizations:List your parents union affiliations:Religious preference: (optional)Is your parent/or grandparent a member of the Armed Forces? If yes, which branch?Is your parent/or grandparent a veteran?Disabled veteran?Deceased veteran?In your own words, explain w
6、hy you are applying for a scholarship and state any compelling reasons to justify your need to apply for financial aid. Outline any unusual financial circumstances that would clarify your status and eligibility for a scholarship. (Please only address your financial situation in this area.) Please ty
7、pe your response. Use a separate sheet of paper if necessary.FAMILY FINANCIAL STATUS REQUIRED (One of the two choices below MUST be filled in.)The most recent copy of the Federal Income Tax Return Form 1040, pages 1 & 2 OR a copy of the Passport to Service form MUST BE ATTACHED. (Social Security num
8、ber will be removed after verification made by counselor.) Annual Gross Income:$_Adjusted Gross Income:$_ OR Annual Family Public Assistance:$_(To obtain a copy of the Passport to Service, if your family support comes from public assistance, contact your eligibility worker at San Joaquin Human Servi
9、ces Agency, 468-1000).Date: _ACTIVITIES RECORDName: _ Grade: _List each activity under the appropriate headings. Mark an “X” in grade column to show year of participation. Indicate any office held.SCHOOL ACTIVITIES 9 10 11 12 COMMUNITIY ACTIVITIES 9 10 11 12 Student GovernmentOrganizationsAthleticsC
10、heerleader, Band, etc.Awards, Honors, Summer Programs/Activities(Travel, Camp, Leadership)OrganizationsChurch ActivitiesEmploymentAwards, Honors, otherAchievementHobbies & InterestsCommunity ServiceCheck ALL that apply to you. Special scholarships are available to students in the following categorie
11、s:Agri-Business EducationKey Club _ OfficerAmerican Indian descentInteract Club _ OfficerAsian descentPlanning career in physical, biological or African Americanengineering sciencesChinese descentSports Letter in varsity _ SportFamily name of Louie, Fong, Kwong or WongChild of Stockton FirefighterFi
12、lipino descentPlanning a teaching career_ Elementary_ SecondaryGreek descentVocation training post high schoolHispanic descentMusic majorMexican/American descentMale applying to UC BerkeleyJapanese American descentPlanning to attend Delta CollegeItalian Catholic descentBilingual (2 years minimum ELD program)Nordiska Member, Nord LodgeCalifornia School Employees (Parent)Portuguese descentGATE identified studentCivil EngineeringInsurance field (Parent)
