Desert Mirage High School

Student Name :

DMHS Student ID# :

Coachella Valley Unified School District

Class of 2016

I ______, give my consent for my

signature

scholarship folder to be viewed by scholarship committees, and other individuals.

DMHS Student ID#

Desert Mirage High School

Personal Data

Last: First: Middle:

Birth Date (MM/DD/YYYY): Telephone () -

Parent’s Name:

Address: City: Zip Code:

Father’s Occupation: Mother’s Occupation:

Number of brothers/sisters who are presently attending a 2 or 4 year college:

Number of dependents on your parent’s income, including your parents and yourself:

Savings from work during high school……………..……………$

Parent’s contribution………………….…………...……………. $

Other Sources……………….…………………………………....$

College or University you plan to apply or attend (by priority):

1st: 2nd:

3rd: 4th:

5th: 6th:

(If unsure, list those to which you have applied to or expect to apply. Include community colleges.)

Major you intend to enter: 1st Choice: 2nd Choice:

(If unsure, list those you are considering)

Career Pathway you intend to enter:

(i.e. Teaching, Business owner, law, law enforcement)

If scores available: SAT: ACT: GPA:

Jobs you have held: (Use separate sheet if necessary for the following)

Employer Date Work Description

DMHS Student ID#

Desert Mirage High School

Activities Record

Student Government (positions) / 9th / 10th / 11th / 12th
Organizations/Clubs / 9th / 10th / 11th / 12th
Athletics/Cheerleading / 9th / 10th / 11th / 12th
Awards, Honors, & Other Achievements / 9th / 10th / 11th / 12th
Clubs/Community Service / 9th / 10th / 11th / 12th

Personal Statement #4

· You must include a Personal Statement and up to 2 letters of recommendations.

Personal Statement must include Name and Student ID # at top of page.

It is also recommended to include a title.

Letter of Recommendation/Personal Data

(Provide to those you are asking for letters of recommendation)

Form # 5

· You must also include up to 2 Letters if recommendation (min of 2). Two must be from teachers, administrators, or counselors. The third is recommended that it be from a member of the community not related to you. This can be an employer, volunteer supervisor, church leader, coach, mentors, etc. Use the following “Letter of Recommendation/Personal Data” (Form # sheet to provide more information to those that you ask for letters (this form is not part of your portfolio).

Name: Date of Birth (MM/DD/YYYY): Date:

Address: City: Zip Code: Telephone: () -

Plans for College/University or other post-secondary education/training:

List in order of preference, the colleges to which you have filed, or plan to file an application:

1st: 2nd:

3rd: 4th:

5th: 6th:

Anticipated major or choice of occupation:

Date of graduation: GPA: Class Rank:

Awards/Honors:

Special Interest /Hobbies/Talents:

Clubs/service organizations in school:

Non-school activities (church, community, volunteer work):

Student government/athletic teams:

Father’s occupation: Mother’s occupation:

Number of brothers and sisters at home? Ages?

Number of brothers and sisters in post-secondary education next year?

Parent levels of formal education:

Father Mother

Elementary Ed.
Some high School
High School Grad
Some College
College Grad.