Application Packet 2015

Transcripción

1 Stanislaus County Office of Education Application Packet 2015 The Stanislaus County Office of Education provides scholarship support to assist college-bound seniors as they begin their post-secondary journey through college. Eligibility Requirements (must meet each of these requirements) Must be Class of 2015 graduating senior Must pass CAHSEE Must demonstrate need for financial assistance Must submit FAFSA or Dream Act application by March 2, 2015 Must enroll as a full-time student (12 units minimum) at a community college, 4 year public or private college or university in the United States in the first quarter or first semester of the academic year (no trade or vocational schools/colleges) Selection Criteria (must meet at least one of the following) First generation in immediate family to attend college Financial need Academic performance (GPA, A-G course completion) Completion of a rigorous college-preparatory curriculum Demonstrated leadership and/or community service Important Dates February 10 Application available March 12 Complete application due in the counselor's office -- including transcripts, Student Aid Reports (SAR) available upon FAFSA completion, Recommendation, Commitment and Release Authorization forms May Notification of Access Success College Scholarship Awards and presentation at your school's Senior Awards Night Scholarship Scholarships will be awarded in amounts ranging from $500 to $5,000 based on financial need and college costs. The scholarships are for the first year of college for full time students attending 2 year or 4 year colleges or universities within the United States. Recipients will receive half the funds first semester and half second semester upon successful completion of first semester courses. Stanislaus County Office of Education, 1100 H Street, Modesto, CA , (209)

2 Stanislaus County Office of Education Forms Checklist I have enclosed: Completed Application (pages 3-5) Signed Commitment Form (page 6) (2 part NCR) Authorization to Release Information (pages 7 & 8 double-sided) Copy of high school transcript Copy of your SAR (Student Aid Report) available upon FAFSA/Dream Act completion Copy of any and all Financial Aid awards received (if received after the application and you are awarded a scholarship, you must forward award letters to the County Office of Education) Recommendation form completed by a high school teacher, counselor, or school administrator and sealed in the envelope provided (page 9) Submit completed applications to: School Counselor Completed application materials must be received by Thursday, March 12, 2015 For questions call: Kandy Woerz (209)

3 Stanislaus County Office of Education APPLICATION 2015 Print Clearly Name (MUST be the same as it appears on your FAFSA, and college applications) Student Information Last Name: First Name: Middle Name: (or initial as it appears on the FAFSA) Parent Information: Father s first and last name: Father s cell phone: Mother s first and last name: Mother s cell phone: Gender / Language Male Female Is English your second language? Yes No Race / Ethnicity (select all that apply) American Indian or Alaska Native Black or African American Asian Hispanic / Latino Native Hawaiian or Other Pacific Islander White Other Date of Birth (mm/dd/yyyy) / / Permanent Mailing Address Street Address: City: State: Zip: Phone Number Home ( ) Cell ( ) Your #1 #2 Parent Address #1: #2: Parent s cell phone Father ( ) Mother ( ) 3

4 Academic Information GPA (cumulative weighted) SAT or ACT Enter your best score for each portion. SAT: Critical Reading Math Writing Or ACT: English Math Reading Science CAHSEE (California High School Exit Exam) English score: Math score: Colleges you applied to: Colleges you were accepted by: College you plan to attend next fall? Name: Location: Intended Major: Enrolled in AVID class? Yes NO If yes, in which grades? List high school leadership and/or community service activities in order of significance. Activity Description of role (player, captain, officer, etc.) Grade level(s) Average hours per week Dates: From / To 4

5 Family and Financial Information Family education history: Mother Father Grandparents Have you completed the FAFSA or the Dream Act application? College degree High School Diploma GED Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No FAFSA Dream Act Neither EFC $ (Expected Family Contribution) (Include a copy of the Student Aid Report (SAR) which is sent upon completion of the FAFSA / Dream Act application) Parents' annual income Below $30,000 $30,000 to $50,000 Above $50,000 Residents in your home Total number of people living in my home, including me, my parents, and other family and non-family members. I live with... (check one) my parents my father only my mother only my grandparent(s) a foster family a relative in a group home friend(s) on my own I do not have a permanent home Other When attending college I plan to live: (check one) with my parents in college dorms on my own Briefly explain special family or financial circumstances (own a business, serious health issues, etc.) List all scholarships, grants, and student and parent loans that you plan to accept Amount Name Source In 50 words or less explain what a college degree would mean to you Attach a copy behind this document of the official High School Transcript and your Student Aid Report (SAR) available upon FAFSA / Dream application completion 5

6 Stanislaus County Office of Education Commitment Agreement My signature below acknowledges that I have read, understood, and agreed to ALL of the following: I will need to attend an accredited Community College or four-year public or private college or university and be enrolled as a full time student (12 unit minimum per semester) to receive the Access Success College Scholarship. I understand that trade or vocational schools and schools outside of the United States are not appropriate for this scholarship. I will keep the Stanislaus County Coordinator(s) informed of my current address, telephone number (home and cell), , and school information. I will complete all Access Success College Scholarship forms as requested. I will send a copy of my college transcript to the designated Access Success College Scholarship Program Coordinator at the end of each quarter, semester, and/or term of college. I will report to the Coordinator next fall a copy of the financial aid summary from the college of attendance to include all scholarships, grants, student and/or parent loans that I have been offered and/or accepted. I understand that awards and scholarships are considered a resource and must be included in a student s financial aid budget. If I am awarded a scholarship that exceeds my unmet needs, a reduction of payment or financial aid may occur. / Student's Signature: Print Name: Date: / Parent s Signature: (if student is under 18) Print Name: Date: Retain a copy for your records and future reference 6

7 Release of Confidential Information to Authorized Persons/Organizations By signing and submitting this form, I authorize the Stanislaus County Office of Education to share all information held by the Stanislaus County Office of Education relating to me, including all information I provide in my application including, but not limited to, personal information, such as my name, mailing address, address and date of birth, and information relating to any financial aid awarded to me and my attendance at any higher education institution (together, my Personal Information ), with the College Access Foundation of California ( CAFC ) for the purpose of researching and evaluating scholarships and programs, and to better enable young people to attend college and university. I further authorize CAFC to share my Personal Information (including my name and birth date) with the National Student Clearinghouse in order to verify my enrollment in and attendance at any higher education program to which I am admitted. I also authorize CAFC to share relevant portions of my Personal Information with (i) governmental agencies responsible for administering public financial aid programs, including the California Student Aid Commission, so that CAFC can obtain information on financial aid I receive or to which I may be entitled, (ii) any higher education institution to which I am admitted so that CAFC can verify my enrollment and obtain information on my academic progress (including transcripts), (iii) CAFC s third party service providers, such as CAFC s or the Stanislaus County Office of Education s data management system provider, (iv) research institutions which undertake research on strategies to increase access to and successful completion of higher education programs, where transcripts and similar information are analyzed by such research institutions so that CAFC can obtain information on my academic progress towards a degree or transfer to a four-year degree awarding institution, and (v) any other administrative, law enforcement or governmental agencies to the extent required by order or requirement of a court or such administrative, law enforcement or governmental agency. CAFC monitors the progress of students who receive scholarships funded by it and students served by its grantees and partner organizations so that CAFC can better evaluate the effectiveness of these scholarships and other sources of financial aid in light of its charitable mission. As part of the monitoring process, CAFC may share aggregated information that does not include my Personal Information and may otherwise disclose non-identifying information with third parties for analysis, demographic profiling and other purposes. Any aggregated information shared in these contexts will not contain my Personal Information. I understand that CAFC will take appropriate steps designed to secure and protect the information I provide, to keep it confidential, and to prevent others from connecting this data to me. To the extent possible, except as set forth in this form, any information that could identify me will be removed or changed before such information is shared with other researchers, organizations, or institutions and before any research results are made public in an aggregated form. Except as set forth in this form, under no circumstances will my identity and Personal Information be revealed by CAFC. This authorization will remain in effect until I revoke it, which I may do at any time by contacting Kandy Woerz at (209) Any waiver, modification or amendment of this form will be effective only if acknowledged in by CAFC. Further, I understand that the Stanislaus County Office of Education will maintain a record of this form, that I am entitled to request and receive a copy, and that I may wish to make a copy of this form for my own records. This form will be governed by and construed in accordance with the laws of the State of California, excluding that body of law known as conflict of laws. If any provision of this form is found to be invalid or unenforceable, that provision will be enforced to the maximum extent permissible and the other provisions will remain in full force and effect. Failure to enforce any provision of the form will not constitute a waiver of future enforcement of that or any other provision. This form may be executed in counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. Student Name: Student Date of Birth: Age Parent s Signature: (if student is under 18) Student s Signature: (if student is 18 or over; if student is emancipated) Date: 7

8 Liberación de información confidencial a las personas u organizaciones autorizadas Al firmar y enviar este formulario, autorizo a de Stanislaus County Office of Education a compartir toda la información en manos de de Stanislaus County Office of Education relacionada a mí, incluyendo toda la información que proporcione en mi solicitud, incluyendo pero no limitado a, la información personal, como por ejemplo mi nombre, dirección postal, dirección de correo electrónico y fecha de nacimiento, e información relacionada a las ayudas financieras concedidas a mí y a mi asistencia a cualquier institución de educación superior (en conjunto, mi "Información Personal"), con la Fundación de acceso colegial de California ("CAFC") con el propósito de la investigación y la evaluación de las becas y programas, y para facilitar que los jóvenes asistan a la universidad. Además, autorizo a CAFC a compartir mi información personal (incluyendo a mi nombre y fecha de nacimiento) con el Centro Nacional de Estudiantes con el fin de verificar mi inscripción y la asistencia a cualquier programa de educación superior al que se me haya admitido. También autorizo a CAFC a compartir las partes pertinentes de mi información personal con (i) las agencias gubernamentales responsables de administrar los programas públicos de ayuda financiera, incluyendo la Comisión de Ayuda Estudiantil de California (CSAC), de modo que CAFC pueda obtener información sobre ayuda financiera que yo haya recibido o a la cual yo pueda tener derecho, (ii) a cualquier institución de educación superior que me admitió de manera que CAFC pueda verificar mi inscripción y obtener información sobre mi progreso académico (incluyendo transcripciones), (iii) a proveedores de servicios externos a CAFC, tales como los proveedores del sistema de datos utilizado por CAFC o de Stanislaus County Office of Education, (iv) las instituciones de investigación que llevan a cabo investigaciones sobre las estrategias para aumentar el acceso y la finalización con éxito de los programas de educación superior, por medio de analizar las transcripciones y otra información similar para que CAFC pueda obtener información sobre mi progreso académico hacia un título o transferir a una institución de estudios de cuatro años, y (v) cualquier otra autoridad administrativa, policial o agencias de gobierno en la medida requerida por orden o requerimiento de un tribunal o como autoridades administrativas, policiales o una agencia gubernamental. CAFC supervisa el progreso de los estudiantes que reciben becas financiadas por la fundación y de los estudiantes atendidos por los beneficiarios y las organizaciones asociadas con el propósito de evaluar mejor la eficacia de estas becas y otras fuentes de ayuda financiera a la luz de su misión caritativa. Como parte del proceso de monitoreo, CAFC puede compartir información agregada que no incluya mi información personal e información que no me identifique con entidades externas para llevar acabo análisis, determinar perfiles demográficos y otros fines. Cualquier información agregada compartida en estos contextos no contendrá mi información personal. Yo entiendo que CAFC tomará las medidas apropiadas para asegurar y proteger la información que proporcione, a mantener la confidencialidad, y para evitar que otros conecten estos datos a mí. A la medida de lo posible, salvo lo dispuesto en esta forma, cualquier información que pudiera identificarme será eliminada o modificada antes de que dicha información sea compartida con otros investigadores, organizaciones o instituciones, y antes de que los resultados de investigación se hagan públicos en forma agregada. Excepto como se establece en esta forma, bajo ninguna circunstancia, mi identidad e información personal será revelada por CAFC. Esta autorización permanecerá en efecto hasta que yo la revoque, lo cual puedo hacer en cualquier momento poniéndome en contacto con Kandy Woerz, (209) Cualquier renuncia, modificación o enmienda de este formulario sólo será eficaz si se reconoce por CAFC. Además, entiendo que de Stanislaus County Office of Education mantendrá una copia de esta forma, que tengo derecho a solicitar y recibir una copia, y de hacer una copia de este documento para mis propios archivos. Esta forma se regirá e interpretará en conformidad con las leyes del Estado de California, excluyendo ese cuerpo de la ley conocido como conflicto de leyes. Si alguna disposición de esta forma se encuentra ser inválida o inejecutable, dicha disposición se aplicará en la máxima extensión y las demás disposiciones permanecerán en pleno vigor y efecto. El incumplimiento de cualquier disposición de la forma no constituirá una renuncia a la aplicación futura de esa o cualquier otra disposición. Este formulario puede ser ejecutado en las contrapartes, cada una de ellas se considerará un original, pero todos los que en conjunto constituirán uno y el mismo instrumento. Nombre del estudiante: Fecha de nacimiento: Firma del padre: (Si el estudiante es menor de los 18 años de edad) Firma del estudiante: (Si el estudiante es mayor de edad; si el estudiante está emancipado/a) Fecha: 8

9 Stanislaus County Office of Education Recommendation -- CONFIDENTIAL (To be completed by a high school teacher, high school counselor, or high school administrator.) Please respond briefly to the following questions, sign, and place in the envelope provided. Seal, sign the document on the back of the sealed envelope, then return the envelope to the student. What adversities, obstacles, or challenges has this student overcome to be college-ready? How would you characterize this student s academic work ethic and his or her commitment to prepare for and succeed in college? Is there any other information you wish to share which will help us make our decision about funding a scholarship for this student? What level of recommendation would you give this student overall? Highest recommendation Average recommendation Low recommendation Name (print) Position Subject/Course Signed Date 9