Fillable Los Rios MESA Scholarship Checklist Have you completed (Cosumnes River College)

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Los Rios MESA Scholarship Checklist Have you completed (Cosumnes River College)

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MESA Scholarship Application Checklist
Los Rios MESA Scholarship Checklist
Have you completed and included the following as part of your
application?
! Scholarship Application Contact Sheet
! Math and Sciences Sheet
! Awards, Honors, Achievement and Activities Sheet
! Personal Statement Sheet
! Faculty Recommendation Form
! Faculty Letter of Recommendation in a sealed envelope.
(Indicate the name of faculty member providing your recommendation
on the contact sheet on page 1, and again on page 5.)
! A complete set of transcripts (unofficial acceptable). Include
transcripts from every college you have attended.
To be considered you must deliver your complete application to
your MESA director on or before, but not later than
Wednesday March 20, 2019
NOTE: Handwritten applications will not be accepted.
Contact your director if you have any concerns about obtaining or providing any of the
requirements of the MESA application
1
_____ I am a member of ARC MESA
_____ I am a member of CRC MESA
_____ I am a member of SCC MESA
Los Rios MESA Scholarship Application
2018-2019
Contact Sheet
Please fill out completely by typing the information for each area directly into this file. Take care with formatting –
first impressions are important. Print a copy to submit and save the file for your records.
Name: Major:
Current postal address (#, street, apt, city, CA, zip):
Student ID #:
Telephone: Home: Cell:
E-mail address:
Intended transfer institution:
Anticipated start date at new institution, for example Fall 2020:
NOTE! A faculty letter of recommendation in a sealed envelope must be included with your application.
Please indicate the name of faculty member providing your recommendation below:
________________________________________________________________________
To be considered, deliver your complete application to your MESA
director on or before, but no later than
Wednesday March 20, 2019
Signature______________________________________ Date______________
(For Administrative Use Only)
Transfer Scholarship ____Yes ____No Expected Date of Transfer____________
MESA Director’s Signature _____________________________ Date: _________________
2
Name: _________________________________________________________
Los Rios MESA Scholarship
Math & Science Sheet
Academic success is one part of the scholarship recipient selection process. List all your mathematics, science,
engineering or computer science courses completed at any college or university.
Semester/year
Course number and name
Units
Grade
Leave blank
Include college name if not a Los Rios campus
Note! Don't forget to also include an unofficial copy of all transcripts at the end of your application.
(For Administrative Use Only)
Calculated Science GPA Current Overall GPA from Transcripts
MESA Director’s Signature _____________________________ Date: _________________
3
Name: _________________________________________________________
Los R
ios MESA Scholarship
Awards, Honors, Achievements and Activities Sheet
This is your opportunity to tell us about what your values are and what you have done. Tell us about your participation or
the recognition you have received in school or in other circumstances. Additionally, tell us specifically about your
involvement in and contribution to the MESA program. See the list below for possible topics – these are suggestions only.
There are many other personal, professional or community related items you might include. Please indicate dates or
general time periods for all you include. Limit: 2 pages.
Significant activities, achievements, or accomplishments in your academic or
personal life
" Academic improvement activities, i.e., MESA workshops or AEW's, Math/Chem Boot Camp,
Beacon, campus academic skills workshops (i.e.,WAC, RAD, Science Study Skills, College Success,
Study Skills).
" Contribution to others, volunteering, tutoring/mentoring in academic or other settings, i.e.,
MESA tutor, participation/leadership in community, religious or other organizations, Big
Brother/Big Sister, SPCA, Professional Cluster Group, Project Choice, Life Matters Inc.
" Professional development activities, i.e., student conferences, professional conferences, summer
research programs, time management workshops, academic or professional speaker series,
student leadership retreat, student leadership conference, student leadership forum.
" Participation or leadership in MESA activities, i.e., field trips, outreach activities, speaking,
fundraising.
Participation or leadership in campus or professional organizations other than MESA, such
as SACNAS, NSBE, Engineering Club, Sci-Tech Club, STEM RISE, Research Club, SHPE,
SMEC, MSA, AMSA, Latinos Unidos, Black Student Union, MECHA, Culturas Unidas, ,
Umoja-SBA, Phi Theta Kappa or similar organizations.
" Other academic, or community activities, participation, awards or recognition
" Other personal achievements, accomplishments or successes
4
Name: ________________________________________________________
Awards, Honors, Achievements and Activities Sheet: Page 1
5
Name: ________________________________________________________
Awards, Honors, Achievements and Activities Sheet: Page 2
6
Name: ________________________________________________________
Los Rios MESA Scholarship
Personal Statement: Page 1
In 1000 words or less, tell us your story. There should be some looking back, and some looking forward in
time. Consider including your educational and career goals, and why this scholarship is important to you.
7
Name: ________________________________________________________
Los Rios MESA Scholarship
Personal Statement: Page 2
In 1000 words or less, tell us your story. There should be some looking back, and some looking forward in
time. Consider including your educational and career goals, and why this scholarship is important to you.
8
Name: _________________________________________________________
Los Rios MESA Scholarship
Faculty Recommendation Sheet
Directions for the Applicant:
Ask a faculty member for a letter of recommendation well before the due date. Print and provide them a
copy of this sheet, and share any other application information you think will be helpful to them. Get
their signature on a copy of this sheet for your complete application.
Directions for the Faculty Member:
Please provide a letter of recommendation on a separate sheet of paper with your candid assessment of the
applicant’s intellectual ability, creativity, leadership ability, and educational goals.
Give this form and your letter to the applicant in a sealed, signed envelope, or return them directly to your
campus MESA Director by Wednesday, March 20, 2019.
484-8221
691-7657
Questions?
ARC Director: Matthew Register
CRC Director: Michael Carney
SCC Director: Lorena Jauregui
558-2476
Name of Recommending Faculty Member:
I approve the release of information herein only to authorized officials of the MESA Scholarship
Committee who will determine the applicant's eligibility for a scholarship.
Applicant Signature_______________________________ Date_____________________
Faculty Signature ________________________________ Date _____________________
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Los Rios MESA Scholarship Checklist Have you completed (Cosumnes River College)

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Completed 4 September 2020

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