APAHA SCHOLARSHIP APPLICATION FORM
Date: ______
1.NAME:______
Last First Middle
2.SEX ______BIRTH DATE______
3.ADDRESS:______
4.CITY/STATE ZIP:______
5.DAY PHONE & EVENING/CELL PHONE______
6.EMAIL ______
7.How did you find out about this scholarship?______
8.List high schools/districts attended and dates: ______
9. Class rank _____ out of ______(# in class) 10. GPA _____ on a ___ point system.
11. Have you been accepted into a prospective educational program or college?
Yes_____ No _____Pending______
When will you know?______
If already accepted, enclose a copy of confirmation of acceptance.______
12. Have you received a scholarship from other Asian organizations? ______Which ones:______
13. List scholarships and financial aid you have already received.______
14. If either of your parents or grandparents is a member of APAHA, list their name
(s):______
15. Parents’occupation:______
16. Family income range:______
ON A SEPARATE PAGE (limit response to one-half page, single-spaced, each for items 17, 18 and 20:
17. List your honors and awards with dates.
18. List your civic and community involvement.
19. Explain how scholarship will be used.
20. Write a one page essay on “How I will contribute to the Asian Pacific American Community"
I certify that the information contained in this application is true to the best of my
knowledge. If I become a scholarship recipient, I agree to use the funds for the stated purpose and submit a written report to the APAHA Board of Directors after the semester the scholarship is used.
______
APPLICANT SIGNATURE DATE