______

AAA Arizona ¡Si Se Puede! Scholarship Application

Section 1: Initial Scholarship Eligibility

Please print or type your application and answer every section. Incomplete applications will not be considered. Applicant must meet all of the following criteria.

• Be Hispanic or of Hispanic descent

• Be a U.S. citizen

• Be an Arizona resident

• Be an Arizona high school senior

• Be (or plan to be) enrolled full time as an undergraduate student in Arizona for the

upcoming academic year in an accredited college or university.

• Have earned and maintained a cumulative grade point average of no less than 3.0 on

a 4.0 scale

Section 2: General Student Demographic Information

Name______

Last First Middle

Home Address______

Street City, State Zip

Date of Birth ______Home Phone ______

Email address______

How did you learn about the scholarship? ______

I am the first in my immediate family to attend college: □ Yes □ No

I am currently a high school senior: □ Yes □ No

I plan to attend ______for the ______, ______semester and College/University Summer, Spring, Fall Year

plan to enroll in ______credits.

I am seeking a(n): □Associate’s Degree Projected Completion Date: ______

Major/Academic Program of Study______□Plan to transfer to: ______by______
□Bachelor’s Degree Projected completion date: ______

Major: ______

Arizona Resident: □Yes □ No U.S. Citizen □Yes □ No

Gender: □ Female □ Male

Status: □ Single □ Married □ Single Parent

Section 3: Personal Statement of intentions and goals

Attach no more than (2) two pages, typed, describing in your own words your career goals and commitment and how the AAA ¡Si Se Puede! Scholarship will help attain them.

Section 4: Please include with application all of the following:

• Official high school transcript

• Copy of letter of acceptance to school or proof of enrollment

• Two (2) letters of recommendation

• Proof of citizenship

• Statement of intention and goals
Submit completed application with the above information to ; or mail to AAA Arizona, Attn: Internal Communications, 2375 E. Camelback Road, Ste. 500, Phoenix, AZ 85016; or fax to 602-776-0466. Applications must be received by April 4, 2014.

The above statements are true and correct to the best of my knowledge.

______

Applicant Signature Date

______

Parent or Guardian Signature (if not 18 yrs of age or older) Date