Application for Referral

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					   Student Application for Fred Aves Career                                                                 Los Angeles Community College District
      and Technical Program Scholarship
                                                                                                                        L.A. Mission College
                                   Academic Year 2010-2011
Student Information
Last Name                                     M.I.        First Name                                   Date of Birth                  Student ID

Address                                                                                  City                                 State         Zip Code

Phone Number                                  Alternate Phone Number                     Email Address                                      Gender (optional info)

                                                                                                                                                   Male       Female
College of Enrollment               Major                                      Educational Goal (e.g. AA, BA, MBA)                    Career Goal

Financial Aid                          Hobbies/Interest
  Currently eligible (check one)

     Yes                 No
Ethnicity (optional):         Asian/ Pacific Islander          Black          Hispanic/Latino        Middle Eastern          Native American              Caucasian
Highest educational level completed?            9 grade          High School/GED            2 yr. College      4yr College        Graduate School              Trade School

Area of Study (check all that apply)

    Administration of Justice                                  Computer Science Information Technology                   Interior Design
    Business Administration/Finance/Marketing                  Culinary Arts/Food Service                                Multimedia/Arts
    Child Development                                          Family & Consumer Studies                                 Nutrition
    Computer Application & Office Technology                   Gerontology                                               Paralegal

    Other (please describe)

School and Community Involvement
School Involvement                   (Please describe your involvement)


Organization                         (Please describe your involvement)

Name of Organization

Are you participating in campus student services programs?

(check all that apply)        Financial Aid             DSPS           EOPS         CalWORKs           Foster Care/Kinship
   Other (describe):

If awarded the scholarship, how will these funds be used?
Briefly describe what you intend to purchase with the award monies. How will these funds help in completing your education?

Student Signature: ___________________________________________________ Date: ___________________________________

Fred Aves CTE Scholarship Application 09-10                                                                                                                     Page 1 of 2
Student Name:                                                                   Student ID
                     (print name clearly)

                    LACCD Fred Aves CTE Scholarship Application

                                       Internal Office Use Only (Please do not write below.)
Financial Aid                     Current GPA    Active Units For Fall       Active Units For Spring   Qualified
Currently eligible (check one)                   Semester 2010               Semester 2011
     Yes            No                                                                                    Yes      No

Fred Aves CTE Scholarship Application 09-10                                                                        Page 2 of 2

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