CalR'i'A
Ca/1fom1a
Retired
Teachers
Association
DIABLO VISTA
SCHOLARSHIP FOUNDATION
SCHOLARSHIP APPLICATION INFORMATION
2016
Dear Applicant:
The purpose
of
the CalRTA - 52 Diablo Vista Scholarship Foundation is to provide needed financial support to
graduating Diabfo
Valley College
or
Los Medanos College students transferring to junior status
in
a four-year
accredited institution.
The goal
of
the Foundation is to annually establish the number and amount
of
the
sc
holarship awards for that year,
consistent with its financial resources. The scholarships awarded each year
will continue for two years and expire
at the end
of
that time. This year several two-year scholarships for $5.000.00 will be awarded. Proportionate
payments
will be made each term over two years. At least one
of
the scholarships
is
intended for applicants
choosing the teaching profession as a career and another one for a re-entry woman.
Scholarship awards are contingent on the recipients being enrolled "full time"
at
the
"t
ransferred to" institution
carrying a
full course
of
study leading to a degree.
Scholarships are awarded on the basis
of
academic achievement, community service, leadership, citizensh
ip,
and
the extent
of
financial need without regard to race,
re
ligion, gender
or
age except for the scholarship for the re-entry
women which
is
partially based on gender and age.
Scholarships are reviewed
and
a partial disbursement is made every semester
or
every term for two years. It will be
the responsibility
of
the recipient to provide the Foundation with the proper information for review and renewal. The
Foundat
ion
must
be
notified
of
any changes in address, institution attending, scholastic standing,
or
any material
information that might affect the continuance
of
the award.
To
qualify for a CalRTA - 52 Diablo Vista Scholarship you must be:
1. A Citizen
of
the United States
2.
Currently enrolled full time at Diablo Valley College
or
Los Medanos College
3.
Eligible for transfer to an upper division program
in
a four-year accredited institution
4.
Expecting to enroll full time
in
an undergraduate program at a four-year institution and carry a full
schedule leading to a degree
5.
Able
to
provide evidence
of
financial need if requested
Applications are reviewed duri
ng
March
of
each year. The names
of
the winners will be submitted to the
Foundation Board for final approval. The names
of
the students selected for the scholarship awards will
be
announced
at
the School Awards Ceremony
of
Diablo Valley College and Los Medanos College. However, the
CalRTA-
52
Diablo Vista Scholarship Foundation's acceptance
of
the award obligation will be made official at their
awards luncheon on the first Wednesday
in
June. A recipient
of
an award should be present at the luncheon.
He/she may be excused from attending the luncheon
if
there is
an
unavoidable time conflict. Approval to be
excused must be obtained from the
Scholarship Selection Committee Chairperson a reasonable period
of
time prior
to the luncheon.
Scholarship award funds are disbursed on a semester
or
quarter basis to the recipients after the Treasurer
of
CafRTA -
52
Diablo Vista Scholarship Foundation has received and reviewed their transcript for eligibility for
payment.
All recipients will receive a letter from the Treasur
er
with detailed instructions.
Applications must be typed. Failure to
fully complete the application may be cause for disqualification.
Applications must
be
returned
to
the Financial Aid Office of Diablo Valley College or Los Medanos College no later
than February
1,
2016.
DIA
BLO VISTA SCHOLARSHIP FOUNDATION
SCHOLARSHIP APPLICATION FORM
The application packet
must
consist
of
:
1.
Completed application form
2.
Electronic transcripts from all post-secondary
in
stitutions including Diablo Valley College
or
Los
Medanos
College
3. Copy
of
current class schedule
4. A typed statement up to
500 words covering your career goals, community service, school
experiences, financial need and any other information considered important
5. Two typed letters
of
recommendation; either two from faculty members
or
one from a faculty member,
and one from a community member who
is
a non-related individual familiar with your academic ability,
community service experience, and leadership qualities
Applications must be typed. Failure to fully complete the application may be cause for rejection.
The
deadline for submitting your completed application packet
for
2016
is
February 1, 2016. The packet must be
submitted to your Financial Aid
Office on
or
before the deadline date.
1.
PERSONAL INFORMATION
Name
(Last} (First}
(Middle)
Permanent Address
(Number} (Street} (Apt.#}
(City)
(State}
(County)
(Zip Code}
Telephone # ( Cell
Phone#
(
Email Address:
Gender:
Male
(J
Female
(J
SS# Date
of
Birth
Marital Status:
Single
CJ
Married
CJ
Divorced D Separated D
Do you have any dependent children? No D Yes D How many?
Ages
Names and addresses
of
parents
or
guardian
Excluding yourself. how
many
dependents
do
your parents have?
Their ages
Of
these dependents how
many
are in college at least half time?
2.
EDUCATIONAL INFORMATION
High School graduated from
City
State Year
graduated
Degree pursui
ng
at DVC
or
LMC
Units
earned
GPA
2. EDUCATIONAL INFORMATION (continued)
List accredited institutions registered in/or applied to for fall 2016.
Your proposed major
Expected profession
3.
ACTIVITY,
WORK
ANO AWARD INFORMATION
List school and/or community activities
dur
ing the last four years. Indicate activity, offices, awards, period
of
time.
List work experience during the
last four years. Indicate company, type
of
work, duties. period
of
time with each
employer.
4.
FINANCIAL INF
ORMAT
ION
Gross income for 2015 Estimated for 2016
If
residing with parents. what was their combined gross income for 2015
Indicate
in
dollar amounts estimated college costs for your school year 2016/2017
Tuition$ Living expenses $
Books$
Miscellaneous (specify)
Total expenses $
In
dicate
in
dollar amounts income expected from various sources for the school year 2016/2017
Summer and/or part-time work $ Scholarships/grants $
Loans (specify)
4.
FINANCIAL INFORMATION, CONTINUED
Other sources (specify)
Total income $
Any comments related to expenses and income
Your signature on this application certifies
th
at
:
1.
This scholarship will help you continue your college work.
2.
You will become a full-time undergraduate student as
of
Fall 2016.
3.
You
will carry a full schedule each term leadi
ng
to a degree.
4. You acknowledge that you must maintain
at
least 2.0 GPA to be considered for renewal
of
the
scholarship.
5.
You
will use the scholarship funds only for
th
e payment
of
tuition, required fees. instructional materials
and books.
Additional Comments (if desired):
Consent is given to the CalRTA - 52 Diablo Vista
Scholarship Foundation to obtain academic, financial,
or
other
information deemed necessary by the
Scholarship Foundation. I also authorize and consent to the use
of
my name
and
visual image by Ca!RT A
if
I am selected as a scholarship recipient for appropriate purposes, including but not
limited to:
still photography, videotape, electronic and print publications and websites. I understand that this
Agreement
in
no way obligates CalRTA to publish
or
use the above-described information. I give the consent with
no claim for payment.
Signature
Parent/Guardian
(If under 18)
Date
Date
click to sign
signature
click to edit
/
C
IR
~
DIABLO
VISTA
a
~.11\.
SCHOLARSHIP
FOUNDATION
Ca//forn101
Retired
Taachers
Association
Scholarship
Recommendation
TO
THE STUDENT: Complete the
student
name and contact infonnatlon.
Submit
recommendation
fonns
for
two
recommenders
to
complete. We require recommendations as
follows:
two
recommendations
from
faculty members,
or
one
from a faculty member and one
from
a
community
member
who
is
a non-
related individual familiar
with
your
academic ability,
community
service experience, and
leadership
qualities. The recommendations
must
be returned
with
your
application packet.
STUDENT'S NAME:
Last
First
Middle
ADDRESS:
Number
Street
City State
Zip
TO THE RECOMMENDER: This student is applying
for
a scholarship and needs support infonnation. It is essential that
we
have a fair and candid evaluation
of
the student's ability and character. While completing this
form, please take into consideration the student's performance and general attitude toward
education.
Return the completed recommendation
to
the
student
Print
Name
Department
Organization
Job
Title
1.
How
long have you known
the
applicant?
2. Under what circumstances have you known the applicant?
3. How
do
you perceive the applicant's academic potential?
4. What are the applicanfs personal strengths and limitations?
5. Please evaluate the applicant in
the
following areas that best describe him/her:
Dependability
Initiative
(OVER)
Leadership
Character
6.
Additional Comments (School activities, community involvement, employment reliability, initiat
iv
e):
D
STRONGLY
RECOMMEND
D RECOMMENDED
SIGNATURE
D
D
RECOMMEND WITH SOME RESERVATIONS
NOT
RECOMMENDED
DATE