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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

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

COMPLETE THE APPLICATION CHECKLIST PAGE:

ELIGIBILITY REQUIREMENTS:

1.  Cumulative GPA 2.5 with a GPA of 2.7 or better in Science, Technology, Engineering and/or Math Courses.

2.  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.

3.  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.

4.  Have filed a FAFSA with Financial Aid.

5.  Must be continuing at CCSF for the next academic year. (Fall 2012/Spring 2013)

OBTAIN TWO LETTERS OF RECOMMENDATION

Please submit two current letters of recommendation from CCSF 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.

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.

1.  Discuss your education and career goals, including any degrees or certificates that you would like to earn in Science, Technology, Engineering, or Mathematics.

2.  Steps that you have already taken to reach these goals, including STEM-related work or volunteer experience.

3.  How does City College fit into your goals?

4.  What has made you interested in Science, Technology, Engineering or Mathematics.

5.  Any extenuating circumstances that affect your financial need. (Optional)

UNOFFICIAL TRANSCRIPTS AND COURSES IN PROGRESS

Please submit an unofficial CCSF transcript and a print-out of your current courses-in-progress for Spring 2010. You may access your transcript online at the CCSF web site. (www.ccsf.edu)

COMPLETE ADDITIONAL ATTACHMENT

Submit your Student Activity Report from the Financial Aid Office

SIGNATURE

REVIEW YOUR APPLICATION FOR COMPLETENESS

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CCSF 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.

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NAME:

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Last First Middle

CCSF ID#: / BIRTH DATE:

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CURRENT ADDRESS:

Street Address or P.O. Box

City / County / State / Zip
HOME PHONE: / WORK PHONE:

E-MAIL: ______

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WILL YOU AND YOUR SIBLINGS BE THE FIRST GENERATION IN YOUR FAMILY TO GRADUATE FROM COLLEGE?
WHAT OTHER COLLEGES HAVE YOU ATTENDED?
WHAT DEGREES DID YOU EARN?
NUMBER OF UNITS COMPLETED AT CCSF: / NUMBER OF UNITS IN PROGRESS
AT CCSF:

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CUMULATIVE G.P.A. AT CCSF:
WHAT IS YOUR FIELD OF STUDY?
WHAT IS YOUR CAREER GOAL?

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WHEN DO YOU EXPECT TO FINISH YOUR STUDIES
AT CCSF? / Month / Year
IF YOU PLAN TO TRANSFER TO A FOUR-YEAR COLLEGE, AT WHICH SCHOOL DO YOU INTEND TO ENROLL?

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Last Name / First Name

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AGE : / GENDER: / Citizenship Status
A U.S. CITIZEN, U.S. TEMPORARY RESIDENT
NATIONAL OR REFUGEE/ASYLEE
U.S. PERMANENT RESIDENT? STUDENT VISA
OTHER
PLACE OF BIRTH:
ETHNIC BACKGROUND : / African-American American Indian Pacific Islander
Asian White Non-Hispanic Other Non-White
Filipino Hispanic Decline to State
DO YOU CONTRIBUTE TO THE SUPPORT OF OTHERS? (Dependants)
IF YES, WHAT IS THEIR RELATIONSHIP?

HOUSEHOLD INCOME

My household’s annual taxable income for 2009 was:

$0 - $15,315 $25,756 - $30,975 $41,416 - $46,635

$15,316 - $20,535 $30,976 - $36,195 $46,636 - $51,855

$20,536 - $25,755 $36,196 - $41,415 over $51,856

THESE AMOUNTS NEED TO BE UPDATED BEFORE RELEASE OF APPLICATION

How many people are being supported by this income?

Last Name / First Name

ADDITIONAL ACTIVITIES

List organizations, clubs and extra-curricular activities in which you have been active at CCSF:
List community and volunteer service:
What college, community and high school awards or commendations have you received?

Please give us any additional information that will assist us in evaluating your financial need. If you anticipate a reduction in income, please explain.

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 CCSF 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:

NOTE: All decisions of the NSF-STEM Scholarship Committee are final.