ALLEN E. BROUSSARD SCHOLARSHIP FOUNDATION

SCHOLARSHIP APPLICATION

(NOTE: ALL INFORMATION PROVIDED IS CONFIDENTIAL AND MAY BE SUBJECT TO VERIFICATION)

Personal Information

Name:______

Address:______

Daytime Phone No.:______Evening Phone No.:______

E-Mail: ______Social Security No.: ______

Date of Birth:______

Race/Ethnicity: ______

Are you the first person in your immediate family to attend college? ______

Are you the first person in your immediate family to attend graduate school? ______

Marital Status: Married ______Single ______Separated ______

Dependent Children: ______Ages: ______

Academic History

Institutions Attended

Law School(s):

Name of School: ______GPA: ______

Dates of Attendance:______Year(s) Completed: ______

Name of School: ______GPA: ______

Dates of Attendance:______Year(s) Completed: ______

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Academic History (continued):

Undergraduate/Graduate School(s):

Name of School: ______GPA: ______

Dates of Attendance:______Year(s) Completed: ______

Name of School: ______GPA: ______

Dates of Attendance:______Year(s) Completed: ______

Honors/Awards (Undergraduate/Graduate School):

Honor/AwardYear(s)

Law School Activities, if applicable

Organization Years InvolvedOffice Held

Community Service (include all activities since graduation from high school)

OrganizationYears InvolvedActivity

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Financial Information

Parent’s or Guardian’s Annual Income (or if you are considered independent for purposes of financial aid, your annual income):

______$70,000 +______$60,000-$70,000______$50,000-$60,000

______$40,000-$50,000______$30,000-$40,000______$20,000-$30,000

______$10,000-$20,000______$10,000 or less

Employment History (beginning with most current):

Employer (including address and supervisor)PositionPeriod of Employment

Present Indebtedness:

Creditor1234

______

______

______

______

______

______

______

In Column 1, state the amount of your current monthly payments

In Column 2, state the total outstanding debt

In Column 3, state the pending payments (not currently due) and date on which payments are scheduled to begin

In Column 4, state the total amount you expect to pay during the current year.

Are you the recipient of any other law school scholarships? _____ If so, how many? ______

Please list the resource and total scholarship award(s) received.

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Required Attachments

  1. Certified Transcript (students entering their first year of law school should submit their college transcript)
  2. 400 word essay on why you should be awarded a scholarship or personal statement.
  3. Letter of admission from a California law school (and if applicable proof of attendance)
  4. Two letters of reference (from teachers/professors/employers)

Application must be received no later than April 28, 2017.

Send all application materials by email to:

Or mail to:

Cheryl Stevens

Deputy County Counsel

County of Santa Clara

70 West Hedding Street

East Wing, 9th Floor

San Jose, CA 95110

If you have any questions you may email the Broussard Scholarship Committee at r call (510) 914-3724

I authorize the Allen E. Broussard Scholarship Foundation to verify any of the information submitted above.

I declare under penalty of perjury pursuant to the laws of the Sate of California that the information I have provided for the Allen E. Broussard Scholarship Foundation is true and correct to the best of my knowledge.

Dated: ______

______

[Print Name][Signature]

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Scholarship Award Rules

The following criteria will be considered in awarding the scholarships:

  1. Academic record (which may include, but is not limited to grades, participation in law review, moot court, or working as a teaching fellow);
  2. Extracurricular activities (with emphasis on service oriented extracurricular activities directed towards the enhancement of opportunities for minorities);
  3. Letters of recommendation;
  4. Financial need; and
  5. Applicant’s essay

The scholarship application must include:

  1. A completed application.
  2. A copy of the applicant’s certified law school transcript. Students who are entering their first year law school must submit a college transcript.
  3. Two letters of recommendation, preferably from a teacher, professor or employer.
  4. Proof of admission (and if applicable proof of attendance) to a California law school in the Bay Area.
  5. A 300-word essay on why you should be awarded a scholarship or personal statement.
  6. Scholarship application and supporting materials must be received by April 29, 2016 and sent to:

Cheryl A. Stevens

Deputy County Counsel

County of Santa Clara

70 West Hedding Street, East Wing, 9th Floor

San Jose, CA 95110

  1. Notification: The Committee will send letters or emails to all applicants no later than May 7, 2016.
  2. Award: The scholarships will be awarded during the Alameda County Board of Supervisors meeting in May, 2016. The award must be used during the 2016-2017 academic year.
  3. For additional information send an email to

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