Fillable SEEDS Application041715 SEEDS Application041715 SEEDS Application011015 (San Diego Mesa College)

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SEEDS Application041715 SEEDS Application041715 SEEDS Application011015 (San Diego Mesa College)

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  • 28 check-boxes
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SEEDS Scholars Program
Undergraduate STEM Student Recruitment, Retention, and Transfer Program
APPLICATION CHECKLIST
READ AND FOLLOW ALL INSTRUCTIONS CAREFULLY Submit materials to:
SEEDS Selection Committee
Send electronic submissions to (preferred):
llopez@sdccd.edu
Include “SEEDS Application” in the subject line
Address ground mail submissions to:
Dr. Leticia P. López
7250 Mesa College Drive, G-248
San Diego, CA 92111
Please be sure to include/complete the following materials:
1.
Application. Completed, signed, and delivered by May 6, 2015. We frequently
communicate with applicants by e-mail. Provide a reliable e-mail account that you check
and use often.
2. Letters of Reference. Submit two letters of reference to our office. One of the letters
should be from a teacher or other person qualified to evaluate your scientific a
nd
academic background. The other letter should come from a community member and
address your conscientiousness, perseverance, and/or curiosity. Community references
should come from someone with experience interacting with adolescents/young-adults
(e.g. coach, work supervisor, church leader). Letters may be sent by the author to our
offices directly, or you may submit copies with this application
.
3.
Transcripts. Attach unofficial copies of your transcripts from Reg-E of current and past classes
taken at Mesa College.
Questions? Contact: Dr. Leticia P. López, E-Mail: llopez@sdccd.edu
, PH: 619-388-2353
For more information, visit our website at www.sdmesa.edu/seeds
FUNDING FOR SEEDS IS PROVIDED BY THE NATIONAL INSTITUTE OF FOOD AND AGRICULTURE,
U
NITED STATES DEPARTMENT OF AGRICULTURE.
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STUDENT INFORMATION:
Today’s Date: ________________________
Name: ______________________________
Date of Birth: ________________________
High School: _________________________
Address: ____________________________
Home Phone: ________________________
Cell Phone: __________________________
E-Mail: _____________________________
Gender:
Male Female
Are you Hispanic or Latino?
Yes No
Select All That Apply:
Mexican Mexican-American Chicano
Central American South American Hispanic Other
What is your race/ethnicity? (Check one or more)
Asian Indian
Chinese
Japanese
Korean
Laotian
Cambodian
Vietnamese
Filipino
Asian Other
Guamanian
Hawaiian
Samoan
Pacific Islander Other
Black or African American
American Indian/Alaskan
Native
White
Other
ACADEMICS:
What degree(s) & major(s) are you currently considering as your goal in college?
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If you have considered where you plan to earn a baccalaureate degree, please list which
four-year colleges or universities you will be applying to for transfer admission after attending
San Diego Mesa College.
RESIDENCY/CITIZENSHIP:
Please indicate:
U.S. citizen Permanent resident
ADDITIONAL INFORMATION:
Check box, if applicable:
First-generation college student EOPS student Disabled
Mother/Guardian’s level of education and occupation:_____________________________
Father/Guardian’s level of education and occupation:_____________________________
Have you applied for and received financial aid?
Yes No
If so, please explain current award:
List any extracurricular or volunteer activities:
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List any clubs or organizations you joined during high school or currently enrolled in Mesa College:
List academic honors and/or scholarships earned:
List any community service or volunteer work:
Are you presently employed? If so, where do you work and how many hours per week?
LETTERS OF REFERENCE:
List the names of two individuals who have written your letters of recommendation?
1. _____________________________ (academic)
2. _____________________________ (community)
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! Page 5 of 6!
Please describe your career goals:
Please describe your background with various cultural experiences:
Please describe your interest in science:
Please describe how you learned about the SEEDS Scholars Program:
Why would you like to join the SEEDS Scholars Program?
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! Page 6 of 6!
TRANSCRIPTS
Please upload your unofficial transcripts from Reg-E of current and past classes
taken at Mesa College.
CERTIFICATION
I certify that all the information provided in this application is accurate and complete, to the
best of my knowledge. The SEEDS Scholars Program has my permission to contact the
admissions or registrar office for student record verifications. If selected into the SD Mesa
College SEEDS Scholars Program, I understand that providing false information is grounds for
dismissal from the program.
Student Name (printed):
Signature: Date:
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BELOW!FOR!OFFICIAL!USE!ONLY!
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Candidate No. ___________ Writing Assessment Score _________
Date Received ___________ Math Assessment Score _________!
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Completed 21 July 2020

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