TEQUIO SCHOLARSHIP FUND

Mixteco/Indígena Community Organizing Project (MICOP)

P.O. Box 20543 Oxnard, CA 93034-0543

Tel: 805 483-1166

2017TEQUIO SCHOLARSHIP APPLICATION

Name: ______

Address: ______

Phone number: Email: ______

Current school:______Grade:______

Name of college/university: ______

( ) Enrolled( ) Plan to enroll

Please indicate which major or field of study you plan to pursue:______

Please indicate your current GPA: ______

Note: To qualify for Edison Scholarship, you must be planning to pursue science, technology, engineering or math (STEM), plan to enroll full-time in college or at a four year university and have a cumulative GPA of 3.0 or higher.

What year will you be in for the 2017-2018 academic year?

( ) Freshman/first year in college

( ) Sophomore/second year in college

( ) Junior/third year in college

( ) Senior in college hoping to go to graduate school.

( ) Other (Please explain:______

Are you/have you been involved with MICOP’s Tequio Youth Group: Yes___ (for how long?______)No____

PERSONAL STATEMENT (1-2 pages)Please help us get to know you. Your statement must include the following:

1)What are your goals? What do you hope to achieve through higher education?

2)Please describe your commitment to the indigenous immigrant community.

3)How will this scholarship specifically support your educational plans? How do you expect to spend the funds?

4)How will achieving your educational goals positively impact the indigenous immigrant community?

Please include (all of the below required documents):

-2 Letters of Recommendation

-High School or College Transcript (offical or unofficial)

-Proof of college classes enrollment (if available)

-Photo of self (headshot preferred) and four sentence biography describing your life and your plans

-Signed Authorization to Use Information, Name, or Likeness (Form is printed on back of this page)

Please email, mail or provide in person all required documents (if emailed, scanned into a single PDF or JPEG is preferred). Incomplete applications will not be considered.

While we understand that for some, this may be more comfortable to complete in Spanish, we are asking that it be completed in English. Thank you for applying and for your dedication to the indigenous community of Ventura County!

Applications due May 5th, 2017. The application must be postmarked or received by 5:00 p.m.on this date. Please email to: , or mail to MICOP, P.O. Box 20543, Oxnard, CA 93034-0543

or drop off to: 520 W. Fifth St., Suite G, Oxnard CA 93030. Questions? Call ArcenioJ . López at 483-1166. Ext. 318

TEQUIO SCHOLARSHIP:

AUTHORIZATION TO USE INFORMATION, NAME, AND LIKENESS

I understand that MICOP requires the right to use my name and likeness, as well as information from my Scholarship Application, personal statement, and letters of recommendation as part of its publicity about MICOP’s Tequio Scholarship Fund, and fundraising for MICOP’s Tequio Scholarship Fund, and their other programs. I hereby authorize MICOP to use my name and likeness, as well as information from my Scholarship Application, personal statement, and letters of recommendation, atits discretion.

______

Candidate Signature Date

IF UNDER 18 YEARS OLD:

Parent SignatureDate