Portraits of Student Success & Scholarship Application Instructions

Eligible California Community College CalWORKs Students will automatically be considered for a region scholarship. All submissions must follow the following guidelines to be considered.

1.  The following documents must be completed and submitted as indicated below to be considered:

  1. Portraits of Student Success and Scholarship Application Form
  1. Signed Release of Authorization

c.  One Page Personal Statement addressing the following questions in an essay format. (500 word maximum. Please use page provided below for your personal statement)

o What challenges have you had to overcome to pursue your degree/certificate?

o What successes have you had in making progress toward your educational and career goals?

o How has the Community College CalWORKs program helped you meet your goals?

o What are your plans to become self sufficient?

o In what ways have you been involved in advocacy, student leadership, community service and/or extracurricular activities?

d.  Photo of student, may include family no collages. Please attach to the last page of this application. The quality of the photo you provide will determine the quality of the photo in the publication. Scanned photos will not be accepted.

  1. Scholarships will be reviewed on a competitive basis taking the following into consideration: Employment, Extra Curricular Activities, Advocacy, Personal Statement, Overcoming Challenges, Educational Achievement, GPA.

2.  Students must electronically submit the application, personal statement and photo in one document directly to your college’s CalWORKs Director/Coordinator as a word file. The document must be named as follows :

College Name.Last Name.First Name Example: Gavilan College.Smith.Jane

3.  Portraits of Student Success forms may be received year round for inclusion in the Annual Portraits of Student Success publication.

·  Colleges should receive from students during the month of November.

·  Region representatives should receive from colleges by December 1st.

·  Portraits/Scholarship Committee should receive from region reps by December 20th.

Incomplete applications, old forms and documents that do not adhere to the requested naming convention will not be considered.

Timeline for Portraits of Student Success and Scholarship Application Process
January through December / Portraits of Student Success submissions are accepted
December 1st / Deadline for Portraits of Student Success submissions to be included in current year’s publicaiton. Submit directly to your CCCWA regional representative.
December 20th / Deadline for regional reps to submit directly to CCCWA Portraits committee for submissions to be included in current year’s publicaiton
January 6th-23rd / CalWORKs Association Board/Scholarship Committee reviews and rates submissions.
February 3rd-10th / Draft document will be available on the CCCWA website for review. This will be the colleges and Regional Representatives opportunity to review for errors. Regional Representatives will have until February 16th to notify the portraits committee of any changes to be made.
February 21st-24th / CCCWA Portraits committee will make corrections and send to print. Publication will be given out at annual training in March.

Check List

Required For
Completed / Forms to complete and submit / Portraits / Scholarship
Portraits of Student Success and Scholarship Application Form / X / X
Scholarship Application Form / N/A / X
Recommendation Form / N/A / X
GPA Verified / N/A / X
Release of Authorization Form / X / X
Personal Statement / X / X
Photo / X / X

Portraits of Student Success and Scholarship Application Form

Eligible California Community College CalWORKs Students will automatically be considered for a region scholarship. All submissions will be included in the current year’s publication.

First & Last Name

Community College

Are you a current California Community College CalWORKs Student? YES NO

Area of Study

Educational Goal: (Check all that apply)

AA AS Certification Transfer

Expected Completion Date Graduation Date

Are you currently working? YES NO

If so please complete the following:

Name of organization/company

Position/Title

Length of time employed Number of hours/week

Scholarship Application Form

This form should be completed by current California Community College CalWORKs students interested in applying for a CCCCWA scholarship award.

First & Last Name

College Name

Work experience in which you have engaged, giving approximate periods, dates, and employer names.

(Add pages if necessary)

Employer / Dates/Periods / Position(s)

Community or School activities in the last three years: Please list all extracurricular activities.

(Add additional pages if necessary).

Organization / Dates/Periods / Extracurricular Activities

CCCCWA Student Recognition Recommendation Form

This form must be completed by the California Community College CalWORKs Director/Coordinator in order for the student to be included in the Portraits of Student Success Publication and/or a CCCCWA scholarship award.

Applicants First & Last Name

Applicant’s Current Overall GPA

CalWORKs Program

Director/Coordinator

College Name

District Name

City/Zip Code

Region

Phone Number

Email Address

Reason for recommending this student:

CCCCWA Release Authorization Form

This form MUST be completed by the applicant

Please complete and sign the following statement to authorize the California Community Colleges CalWORKs Association to use your picture and quotes from the CalWORKs Portraits of Student Success Recognition Form and/or CalWORKs Scholarship Application Form.

I, hereby give the California Community Colleges CalWORKs Association a free nonexclusive, royalty-free, irrevocable, world-wide license to use my picture and statements submitted on the CalWORKs Portraits of Student Success Recognition Form and/or CalWORKs Scholarship Application Form in any manner that the California Community Colleges CalWORKs Association wishes including: copying, editing, distribution, performance, display, and promotional purposes, and in any medium that the California Community Colleges CalWORKs Association wishes.

I agree to release and discharge the California Community Colleges CalWORKs Association, its Board of Directors, officers, employees and agents from any liability for any use, misappropriation or disclosure of any information, including, but not limited to, all claims for damages for defamation, insult, invasion of privacy or any other claim based upon the use by the California Community Colleges CalWORKs Association.

______

Student Signature Date

Student First & Last Name
College Name
Area of Study

Insert Photo Here

Personal Statement Here (Maximum 500 words, Times New Roman 12 point font)