Uber Partner Driver Scholarship

Transcription

1 Uber Partner Driver Scholarship ELIGIBILITY CHECKLIST You are eligible to apply for the Uber Partner Driver Scholarship if you answer yes to each of the questions below. 1. I am currently an active Uber Partner driver in good standing and have been a Partner driver for a minimum of six months. 2. I am a US Citizen (US National) or permanent US resident. 3. I am planning to attend, or am currently attending, an eligible college or university in Washington State for the academic year. 4. My cumulative GPA through fall quarter/semester 2014 is at least a minimum of 3.0. I checked yes to all the above. STUDENT INFORMATION First Name John Middle Name Alex Last Name Smith Mailing Address 1605 NW Sammamish Rd City Issaquah State WA ZIP Code Date of Birth 10/10/2001 Gender Male Social Security Number Are you a U.S. Citizen? Are you a Legal Permanent Resident Please provide your Alien Registration A Number Preferred Phone Number Type of Phone Number Home Phone Secondary Phone Type of Phone Number Cell Phone jsmith@sample .com Re-enter Preferred jsmith@sample .com Note: This must be a valid address that you check regularly. If it changes notify the College Success Foundation (CSF) promptly. Please make sure CSF is an approved sender. RACE/ETHNICITY Note: The following questions adhere to the U.S. Department of Education standards for gathering information about a student's race and ethnicity and use the following guidelines: American Indian or Alaska Native (a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment). Asian (a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam). Black or African American (a person having origins in any of the black racial groups of Africa).

2 Native Hawaiian or Other Pacific Islander (a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands). White (a person having origins in any of the original peoples of Europe, the Middle East, or North Africa). Are you of Hispanic/Latino descent (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture/origin, regardless of race)? /No Additionally, what race(s) do you consider yourself? Regardless of your answer to the previous question, please mark the following box(es) to indicate what you consider yourself to be. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White ACADEMIC INFORMATION Academic Attendance High school from which you will receive or have received your diploma: Coupeville High School I am currently a: High School Graduate (Enrolled in College) What college or university are you currently attending? University of Washington High School Graduate (Have Never Attended College) High School Graduate (Not Currently Enrolled, But Have Attended) What college or university did you attend? University of Washington Grade Point Average Your cumulative grade point average (GPA) through fall quarter/semester 2014 must be a minimum of 3.00 (on a 4.0 scale). Enrolled in college/university - If you are currently enrolled in college/university report your college/university cumulative GPA through fall quarter/semester If you attended more than one college, enter the GPA from the college where you earned the most credit. Graduated from high school - If you have graduated from high school, but have never attended college, enter your high school cumulative GPA. Attended college, but not enrolled - If you graduated from high school and attended college, but are not enrolled fall quarter/semester 2014, enter your most recent college/university cumulative GPA from the college/university from which you earned the most credit. Received your GED Enter the score My GPA is from: High School Transcript My GPA is: 3.00 College Transcript My GPA is: 3.25

3 Please provide GPA through two decimal points e.g Academic Plans GED Score My GED score is: 3000 Name of Washington college or university where you will be enrolled during fall 2015: Columbia Basin College Academic areas of interest: Biology Intended Major: Architectural Drafting and Architectural CAD/CADD Expected completion date of baccalaureate degree: 06/01/2017 ACTIVITIES Extracurricular, Personal, and Volunteer Activities List your top three extracurricular, religious, community, family activities and hobbies. Include specific events and/or major accomplishments. 1. Activity name: Animal Shelter Volunteer Positions held, honors won, or letters earned: Shelter Assistant Dates of activity From: 09/15/2011 To: 06/30/2014 Total hours spent on this activity for the timeframe listed above: 362 Paid Work Experience/Student Income Information List the top two jobs (including summer employment) you have held during the past three years. 1. Specific job and nature of work: Soccer Referee Employer: Coupeville Parks and Rec Date of employment From: 07/16/2012 To: 12/15/2014 Approximate number of hours spent per week: 12 FAMILY INFORMATION Total household size Total Household Size: 1 10 people Parent Information What was the highest education level either of your parents attained? Graduate Degree Are you currently placed in, or have you emancipated from foster care? /No Family Benefit Information In your current living situation, is there anyone in your household receiving any of the following benefits in 2014? a. Supplemental Security Income (SSI) b. Supplemental Nutrition Assistance Program (SNAP) c. Free or Reduced Price Lunch d. Temporary Assistance for Needy Families (TANF) e. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Family Benefit Information: /No SHORT ANSWERS Short Answer Introduction Minimum of 150 and a maximum of 300 words are required for each short answer question before the application can be submitted. We strongly recommend that you do the following: Read all the questions first.

4 Outline your response to each question before you begin writing. Use different examples in different responses to build the most complete picture of yourself as a unique student applicant. The more details you include, the stronger your answers will be. Write drafts of each short answer. If it's easier for you, you can write them in Word and paste them into the boxes below. Share draft with a support person or relative. Short Answer Question 1 What are your educational and career goals? What specific steps have you already taken on the path to reaching them? Short Answer Question 2 Describe a time when you faced a personal challenge and share in detail how you worked through the situation. What, if anything did you learn from this experience and how has it influenced your day to day actions and/or goals for the future? APPLICATION CHECKLIST Transcript If you have not yet completed any college credits (other than Running Start), you must submit an official high school transcript, showing all of your classes through fall quarter/semester You may need to request an official transcript from your high school a couple of weeks in advance, so be sure to plan ahead. Note: Those students who did not attend high school in the United States must provide complete, official academic records from secondary (equivalent to high school education in the U.S.) and post-secondary schools. Records should include courses taken, grades received, and degrees or certificates earned. They must be translated into English and evaluated for U.S. credit and must include a cumulative grade point average (GPA). If you are currently enrolled in college or attended after high school graduation, but are not currently enrolled, you must submit an unofficial college transcript, and it must show all your classes through fall quarter/semester 2014, and include your cumulative GPA. Please mail your transcript to: College Success Foundation Uber Partner Driver Scholarship 1605 NW Sammamish Road, Suite 200 Issaquah, WA Your transcript must be postmarked by March 9, 2015 for your application to be considered complete. Note: Postmarked means that the envelope must be delivered to the post office before it closes for the day, or placed in a mailbox before the last pickup of the day. I will mail my high school (official) or college (unofficial) transcript to the College Success Foundation by March 9, AGREEMENT/CONSENT Pledge of Authenticity, Agreement and Consent By my/our signature on this form I/we pledge that: The statements made and circumstances represented throughout the applicant's entire application are truthful to the best of my/our knowledge. The essays accompanying this form are substantively the applicant s own work, although they may have been reviewed by parents, teachers or other advocates. All of the financial information I/we have provided is complete and accurate. By my/our signature on this form I/we understand and agree that: The information submitted in this application will be reviewed by College Success Foundation (CSF) staff and outside consultants for the purposes of selection.

5 Prior to Candidate selection, CSF staff may be in contact with school officials to confirm that the applicant s school attendance and conduct have been at the high level expected by the program. This information may be taken into consideration in the selection process. Additionally, CSF staff will contact Uber to verify the applicant s status as a currently contracted driver that is found to be in good standing. Applicants must be a current active partner driver for Uber to apply and retain eligibility. One of the outcomes of the Scholarship program is to increase knowledge regarding higher education opportunity through research, and the applicant may be contacted by outside consultants in the future and asked to participate in research surveys whether or not they are selected for the Scholarship. The Foundation also reserves the right to not make a monetary scholarship award if the applicant is fully funded to the college/university s annual cost of attendance. If at any time information provided in this application is found to be false or inaccurate, it is sufficient cause for rejection or dismissal from the Scholarship program. By my/our signature on this form I/we consent to: The use of any and all information from this application in connection with CSF research activities. The applicant s individual transcript and will not be made available to the public through CSF research activities in a form that would allow the applicant to be identified, although research results may be made available to the public in an aggregated form, such as an average or a total for a group of students. I, the undersigned student, irrevocably give CSF the right to (1) share information about me (including my name, my college admission or enrollment status, my financial aid status, my academic progress including my cumulative grade point average, my academic major and areas of interest, and other personal and family background information I provide to CSF or any educational institution I currently attend) and (2) use my name, picture, or likeness (the Likeness Materials ) for any program or CSF purpose. Further, I authorize my educational institution to release my academic, financial aid, and any other pertinent educational information to CSF. I waive (1) any rights I may have in connection with use of my information or the Likeness Materials, including any right to own, inspect or approve the form, media or manner of use and (2) any liability resulting from the use of my information or the Likeness Materials. If I am selected as Program participant, I will, upon CSF s request, sign additional releases in form and substance acceptable to CSF. Applicant Agrees: Applicant First Name: John Applicant Last Name: Smith Month: January Day: 16 Year: 2015