Fillable 2016-17 Undergraduate Counselor Verification Form 2016-17_Undergraduate_Counselor_Verification

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2016-17 Undergraduate Counselor Verification Form 2016-17_Undergraduate_Counselor_Verification

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The 2016-17 Undergraduate Counselor Verification Form 2016-17_Undergraduate_Counselor_Verification form is 2 pages long and contains:

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  • 40 other fields

Country of origin: US
File type: PDF

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Instructions:
• This electronic form allows you to download it to your computer, insert the requested information, save it on your computer, later modify and save answers.
• Use additional pages if needed.
• Print a hard copy once you have completed the form. Sign using black or blue ink
• Provide the signed hard copy in a sealed envelope to the requesting student Before February 5, 2016.
• Alternatively you can print the downloaded form, fill it out and submit it using additional pages as needed. We prefer, if possible, that references be typed.
• Do not use the backs of pages or staple pages together.
• If you do fill this out in electronic form, we would appreciate you also sending an electronic copy to the student. Label the attachment: student’s last name,
first name and “Counselor Verification UG KK.” (e.g. Doe_John_Counselor_UGKK)
Student Information
Verification
The above student is applying for a two-year undergraduate Kennedy King Scholarship to enable the student to obtain a Bachelor’s
degree at a four-year institution. A qualification for scholarship consideration is that the student be qualified to transfer with junior
status
1
to such institution next fall or the following spring. Consequently, we ask that the student’s Community College counselor
provide answers to the following questions:
If the answer is YES, nothing more is needed. Please sign below.
1. “Transfer” to a California University or State College system school, i.e. 60 transferable units and successful completion of required courses. We do not expect familiarity with the requirements at every U.S. College or
University. Currently, we understand U.C. Universities do not accept spring transferees. If that or other requirements change, notify oskifox@gmail.com.
2. Please state on page 2 (Counselor Comments) where courses will be taken if not at a CCCD Community College.
First Name
Middle
Last Name
Current Address
City
State
Zip
Mailing Address (if different)"
City
State
Zip
Home Phone Number:
Mobile Phone No:
Email Address:
Community College:"
Student’s Anticipated Major at a Four Year College"
4-Year Colleges/Universities Applied or Applying to:
Transferring:"
Page of 1 2
© 2015 Kennedy-King Memorial College Scholarship Fund Ltd. Updated October 28, 2015
Contra Costa
Diablo Valley
Los Medanos
Fall 2016
Spring 2017
Transferable Units Completed"
Transferable Unit GPA
Transferable Units Currently Enrolled
If the student successfully completes the currently enrolled units, will the student have completed all required
courses and sufficient units to be eligible to transfer with junior standing
2
to pursue the anticipated major
specified above this fall?
Yes
No
P.O. Box 2643 ● Martinez, CA 94553-0264 ● www.kennedyking.org
Confidential
Undergraduate - CC Scholarship Counselor Verification Form
Community College Counselor Name (printed)
Community College Counselor signature !
in black or blue ink
Date
5 digit
5 digit
(555) 555-5555
(555) 555-5555
Only required if Verification Answer is NO
If the answer above is NO
: We require fall and spring transfers to have, with those currently enrolled, a minimum 54 and 42
transferable units respectively.
If the answer above is NO: the student does not qualify, but may apply for the scholarship next year.
If the answer is YES, please provide an Educational Plan agreed by the student listing course names, numbers & units (* required
courses) to be completed with a reasonable probability of successful transfer with junior standing. With the following plan, the
student is reasonably expected to transfer next Fall or Spring
Counselor Comments (If Any)
Counselor Signature (Required If Verification Answer Is No) & Student Agreement
Page of 2 2
© 2015 Kennedy-King Memorial College Scholarship Fund Ltd. Updated October 28, 2015
Can the student reasonably complete the remaining required courses and sufficient units in summer school
(and next fall for spring) to qualify to transfer?
Yes
No
Spring 2016
Summer 2016
Fall 2016
Do the specified colleges accept spring transfers?
Yes
No
Not sure
Community College Counselor !
Name
Title
Community College Name
(printed)
Community College Counselor signature !
in black or blue ink
Date
Student signature !
in black or blue ink
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2016-17 Undergraduate Counselor Verification Form 2016-17_Undergraduate_Counselor_Verification

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Completed 9 April 2020

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