ࡱ>  4bjbj I̟̟&bb%%%%%]B]B]BXC9Doh5E J(5J5J5J LOQnnnnnnn\qsn%RK"LRRn+S%%5J5Jo+S+S+SR"%5J%5Jn+SRn+S+Sg%%ioi#]BR:?hio0oWh8t+St0i+S%iRRRd+]B]Bb :    CITY COLLEGE OF SAN FRANCISCO SCIENCE, TECHNOLOGY, ENGINEERING AND MATHEMATICS (NSF-STEM) SCHOLARSHIP APPLICATION Spring 2012 APPLICATION SUBMISSION DEADLINE: May 18, 2012, 4:00 p.m. NOTE: BE SURE TO COMPLY WITH DIRECTIONS ON THE FOLLOWING PAGE Incomplete applications will not be accepted  FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT        FORMTEXT        Last Name First Name MI Return your application to: The MESA-STEM Center Science Hall (room S142) (415) 452-5598 Instructions for Completing Your Application  FORMCHECKBOX  COMPLETE THE APPLICATION CHECKLIST PAGE: ELIGIBILITY REQUIREMENTS: Cumulative GPA 2.5 with a GPA of 2.7 or better in Science, Technology, Engineering and/or Math Courses. Have completed 7 units of STEM classes at CCSF by end of Spring 2012 Semester and be enrolled in 12 units while in the scholarship program. Must be a citizen or national of the United States, alien admitted to the United States for permanent residents or alien lawfully admitted to the United States for permanent residence. Have filed a FAFSA with Financial Aid. Must be continuing at CCSF for the next academic year. (Fall 2012/Spring 2013)  FORMCHECKBOX  OBTAIN TWO LETTERS OF RECOMMENDATION Please submit two current letters of recommendation from 91¥ Science, Technology, Engineering, or Mathematics instructors who know you and are familiar with your class work and/or school and community activities. The letters should include information that will give the STEM Scholarship Committee insight into your personal qualities, character, special talents, academic attributes, and potential for making a contribution to society. Do not submit more than two letters of recommendation.  FORMCHECKBOX  NSF-STEM PERSONAL STATEMENT Please discuss the following points in 250 to 500 words. Your format is: typed with one inch margins, top, bottom and sides; name and ID in the top right-hand corner; Times New Roman font 12; double- spaced. Discuss your education and career goals, including any degrees or certificates that you would like to earn in Science, Technology, Engineering, or Mathematics. Steps that you have already taken to reach these goals, including STEM-related work or volunteer experience. How does City College fit into your goals? What has made you interested in Science, Technology, Engineering or Mathematics. Any extenuating circumstances that affect your financial need. (Optional)  FORMCHECKBOX  UNOFFICIAL TRANSCRIPTS AND COURSES IN PROGRESS Please submit an unofficial 91¥ transcript and a print-out of your current courses-in-progress for Spring 2010. You may access your transcript online at the 91¥ web site. ( HYPERLINK "http://www.ccsf.edu" www.ccsf.edu)  FORMCHECKBOX  COMPLETE ADDITIONAL ATTACHMENT Submit your Student Activity Report from the Financial Aid Office  FORMCHECKBOX  SIGNATURE  FORMCHECKBOX  REVIEW YOUR APPLICATION FOR COMPLETENESS 91¥ STEM SCHOLARSHIP APPLICATION Spring 2010 Please read all questions carefully and answer them as completely. Appearance and organization of your application will be taken into consideration when judged by the STEM Scholarship Committee. NAME: FORMTEXT        FORMTEXT        FORMTEXT   Last First Middle CCSF ID#: FORMTEXT      BIRTH DATE:  FORMTEXT       CURRENT ADDRESS:  FORMTEXT      Street Address or P.O. Box  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      CityCountyStateZip HOME PHONE: FORMTEXT      WORK PHONE: FORMTEXT       E-MAIL: _____ FORMTEXT      ___________ WILL YOU AND YOUR SIBLINGS BE THE FIRST GENERATION IN YOUR FAMILY TO GRADUATE FROM COLLEGE?  FORMTEXT       WHAT OTHER COLLEGES HAVE YOU ATTENDED? FORMTEXT       WHAT DEGREES DID YOU EARN? FORMTEXT       NUMBER OF UNITS COMPLETED AT CCSF:  FORMTEXT    NUMBER OF UNITS IN PROGRESS AT CCSF: FORMTEXT     CUMULATIVE G.P.A. AT CCSF:  FORMTEXT       WHAT IS YOUR FIELD OF STUDY?  FORMTEXT       WHAT IS YOUR CAREER GOAL?  FORMTEXT       WHEN DO YOU EXPECT TO FINISH YOUR STUDIES AT CCSF? Month FORMTEXT       Year  FORMTEXT      IF YOU PLAN TO TRANSFER TO A FOUR-YEAR COLLEGE, AT WHICH SCHOOL DO YOU INTEND TO ENROLL?  FORMTEXT         FORMTEXT       FORMTEXT       Last NameFirst Name AGE :  FORMTEXT       GENDER:  FORMTEXT      Citizenship Status  FORMCHECKBOX  A U.S. CITIZEN, U.S.  FORMCHECKBOX  TEMPORARY RESIDENT  FORMCHECKBOX  NATIONAL OR  FORMCHECKBOX  REFUGEE/ASYLEE U.S. PERMANENT RESIDENT?  FORMCHECKBOX  STUDENT VISA  FORMCHECKBOX  OTHER PLACE OF BIRTH:   FORMTEXT       ETHNIC BACKGROUND :   FORMCHECKBOX  African-American  FORMCHECKBOX  American Indian  FORMCHECKBOX  Pacific Islander  FORMCHECKBOX  Asian  FORMCHECKBOX  White Non-Hispanic  FORMCHECKBOX  Other Non-White  FORMCHECKBOX  Filipino  FORMCHECKBOX  Hispanic  FORMCHECKBOX  Decline to State  DO YOU CONTRIBUTE TO THE SUPPORT OF OTHERS? (Dependants) FORMTEXT       IF YES, WHAT IS THEIR RELATIONSHIP? FORMTEXT       HOUSEHOLD INCOME My household s annual taxable income for 2009 was:  FORMCHECKBOX  $0 - $15,315  FORMCHECKBOX  $25,756 - $30,975  FORMCHECKBOX  $41,416 - $46,635  FORMCHECKBOX  $15,316 - $20,535  FORMCHECKBOX  $30,976 - $36,195  FORMCHECKBOX  $46,636 - $51,855  FORMCHECKBOX  $20,536 - $25,755  FORMCHECKBOX  $36,196 - $41,415  FORMCHECKBOX  over $51,856 THESE AMOUNTS NEED TO BE UPDATED BEFORE RELEASE OF APPLICATION How many people are being supported by this income?  FORMTEXT        FORMTEXT       FORMTEXT       Last NameFirst NameADDITIONAL ACTIVITIES List organizations, clubs and extra-curricular activities in which you have been active at CCSF: FORMTEXT       FORMTEXT       List community and volunteer service: FORMTEXT       FORMTEXT       What college, community and high school awards or commendations have you received? FORMTEXT       FORMTEXT       Please give us any additional information that will assist us in evaluating your financial need. If you anticipate a reduction in income, please explain.  FORMTEXT       I hereby certify that the information provided above is given freely by me and is accurate to the best of my knowledge. I give permission to release this information to the 91¥ Scholarship Committee and its designee(s). I understand that information involving current abuse and/or threats of violence must be reported to the Dean of Students as required by law. SIGNATURE: DATE: FORMTEXT       NOTE: All decisions of the NSF-STEM Scholarship Committee are final.  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