sclrshpappfall by 7xS3ef

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									                              COLLEGE OF EDUCATION
                                SAN FRANCISCO STATE UNIVERSITY

                      SCHOLARSHIP APPLICATION
                                                 Fall 2012
                       DEADLINE: Monday, March 12, 2012

                           Submission deadlines for scholarship applications are
                          no later than 4:00 p.m. on application dates noted above.
                    Return to: COE Graduate Studies Office, Burk Hall 240, San Francisco
                     State University, 1600 Holloway Avenue, San Francisco, CA 94132.


PART I.
Scholarship Applicant Name _________________________________________________
Student I.D./SSN _________________            Email ____________________________________
Mailing Address (street/city/zip)                       Telephone (day) ___________________________
___________________________________ Telephone (eve) ___________________________
___________________________________ Semester for which you are applying __________
___________________________________ Your Signature ______________________________


Check ( ) all scholarships for which you are applying; limit is four (4). Submit the original application, plus one
copy of complete packet. See Scholarship Listing for eligibility criteria for each award.

       California Retired Teachers Association, S.F.            Dorothy B. Lucas Scholarship
       Laura E. Settle, CA Retired Teachers Association         Abel/Kolterman Scholarship
       Crumpton/Baxter/Bonham Memorial                          William Neer Scholarship
        Scholarship
       Annette McGowan Scholarship                              Chris Larsen Scholarship
       George J. Moscone Scholarship                            Dorothy Misbach Fund
       Cahill Scholarship                                       Karl Richard Lane Fellowship
       Dorothy Westby-Gibson                                    Leon and Miriam Bloomberg Scholarship
       Cahill Scholarship                                       Ken Pfeiffer Memorial Scholarship
       Irvin W. & Velma C. Hartman Family                       Dominic C. Nosenzo Special Education




Reference Letters (2) submitted with this application:

           Name                          Title/Association                 Organization
    ________________________________________________________________________________
    ________________________________________________________________________________
Transcripts submitted with this application (indicate Institutions; unofficial copies accepted):




Scholarship Application/COE                                                                                 Page 1 of 3
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__________________________________________________   Undergraduate   Post-Baccalaureate
__________________________________________________   Undergraduate   Post-Baccalaureate
__________________________________________________   Undergraduate   Post-Baccalaureate




Scholarship Application/COE                                                          Page 2 of 3
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                                                        Scholarship Applicant Name _____________________________

PART II.
STATUS AT TIME OF APPLICATION Check ( ) all that apply and complete information requested.

    As APPLICANT for ADMISSION                                         As CURRENT MATRICULATED STUDENT
 Credential                                                              Credential
          Specify: ___________________________                             Specify: _____________________________
          Semester/Year of application ___________                         First semester enrolled _________________
          Units to be enrolled ________________                            Units completed to date ________________
          Anticipated Year completion________                              Anticipated Year completion____________
          GPA, current cumulative ___________                              GPA, current cumulative ______________
 Master’s degree                                                         Master’s degree
          Specify M.A. or M.S.: ________                                   Specify M.A. or M.S.: ________
          Program: __________________________                              Program: __________________________
          Emphasis: _________________________                              Emphasis: _________________________
          Semester/Year of application ___________                         Semester/Year program started ___________
          Anticipated Year completion___________                           Anticipated Year completion___________
    Do you have a disability?  Yes  No                            Are you a resident of California? Yes  No
    Are you a U.S. citizen?  Yes  No
                  Do you plan to teach in California? Yes  No
                  Do you currently hold a valid California teaching credential?  Yes  No
                        If so, what type? _______________________________________________
Academic Background: List all colleges/universities/schools you have attended.
                                                            Dates                Credential/
          Institution              Location                 Attended             Degree               Date Awarded
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
________________________________________________________
Ethnic Identity: Response is optional. Circle appropriate number or letter code.

      1    – American Indian or Alaskan native:        Tribe____________________________
      2    - Black, non-Hispanic, including African American           L   - Laotian
      3    - Mexican American, Mexican, Chicano                        V    - Vietnamese
      A     - Central American                                         T   - Thai
      B     - South American                                           S   - Other Southeast Asian
      Q     - Cuban                                                    G    - Guamanian
      P     - Puerto Rican                                             H    - Hawaiian
      4    - Other Lantino, Spanish-origin, Hispanic                   N    - Samoan
      C     - Chinese                                                  6   - Other Pacific Islander
      J    - Japanese                                                  7   - White
      K     - Korean                                                   F   - Filipino
      R     - Asian indian                                             8   - Other
      5    - Other Asian                                               9   - No Response



Scholarship Application/COE                                                                                          Page 3 of 3
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    M    - Cambodian          D   - Decline to State




Scholarship Application/COE                            Page 4 of 3
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                                                   Scholarship Applicant name __________________________

PART III.
(1) Have you applied for financial aid with the SFSU Office of Financial Aid?  Yes  No

    If yes, will you be receiving grants and/or loans for the Fall semester?          Yes  No

    If yes, list below or please attach a copy of your Financial Aid Award Letter.




(2) Briefly describe how you plan to finance your education. Describe your need for financial assistance.




PART IV.
Provide your goal statement by responding to the following inquiries. Attach the goal statement to your application.
The selection committee reviews these statements carefully, so please devote serious effort to your statement. Limit
your statement to a maximum of 3 pages. Sign your statement.

          Describe your interest in education and related human services fields.
          Describe your educational and professional goals.
          Describe what you wish to accomplish with the completion of a credential or degree.









Scholarship Application/COE                                                                                 Page 5 of 3
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