The Edison International Scholar Program Science, Technology, Engineering and Mathematic Scholarship Application (STEM)

The Edison International Scholar Program Science, Technology, Engineering and Mathematic Scholarship Application (STEM) 2015-2016 Students who submit completed applications and other required documents by the deadline will be automatically considered for the Mt. San Jacinto scholarships administered by Mt. San Jacinto College. Requirements: Complete the Stem Scholarship Application typed or neatly printed in blue or black ink. For the Fall 2015 and Spring 2016 semester, student must be enrolled in a minimum of 6 credit units and have a minimum cumulative GPA of 3.0. Student must be enrolled in Computer Science, Science, Information Systems, Computer Systems Engineering, or Mathematics. Must have financial need. Complete Financial Statement. Financial need is required for some scholarships and the financial statement must be completed and submitted with your application form. Attach two (2) current Applicant Evaluation Forms. Request two individuals, such as teachers, employers, or community leaders who are familiar with your career goals, to complete this form. Attach an unofficial transcript with all grades from MSJC or other colleges that you may have attended. Please submit your application to the Foundation Office drop box located in the Student Service Building Lobby. San Jacinto Campus Building 1150 or Menifee Campus Building 100. You can also mail your scholarship application to: MSJC Foundation Office 1499 N. State Street San Jacinto, Ca. 92583 No late applications will be considered. Respond to the following essay questions. Do not submit any other document or statement. 1. Major/Goals: Describe why you selected your major area of study and your future academic and career goals. 2. Adversity/Challenges: Describe any adversity or challenges you have overcome or anticipate in pursuit of your educational goals. APPLICATION DEADLINE IS FRIDAY, February 20, 2015 by 12:00 noon Decisions of the scholarship committees are final. Eligibility does not guarantee a scholarship. 1

The Edison International Scholar Program Science, Technology, Engineering and Mathematic Scholarship Application (STEM) 2015-2016 PERSONAL INFORMATION MSJC I.D #: Name: LAST FIRST MIDDLE Current Mailing Address: NUMBER STREET APT.# CITY Zip Phone Number: ( ) Birth Date: Last High School Attended: Name of High School State Graduation Date Colleges attended other than Mt. San Jacinto College Name of College Units Dates Cumulative GPA ENROLLMENT PLANS: Do you intend to register full-time in the following semesters at MSJC (check all applicable semesters)? Fall 2015 Spring 2016 Are your registration fees & books currently being paid by a program or someone other than yourself? Yes/ No Program: Amount $: Are you a single parent with dependent children living with you? _ Yes No Are you a re-entry student (out of school at least one year)? Yes No 2

FINANCIAL STATEMENT Many scholarships include financial need as a criterion. This form must be completed for you to be considered for financial need based scholarships. It is essential that this form reflect a true picture of your household finances. Please be as candid as possible. Report all income in yearly figures (monthly x 12) for the calendar 2014. Income information for 2014 APPLICANT S HOUSEHOLD SIZE (Please do not include roommates) ANNUAL HOUSEHOLD INCOME Note: indicate income received for the calendar year 2014 only APPLICANT S/SPOUSE S INCOME (if applicant currently married) Income/wages $ (student) $ (spouse) Child support received $ (student) $ (spouse) Alimony received $ (student) $ (spouse) Social Security $ (student) $ (spouse) Military housing (benefit amount) $ (student) $ (spouse) Other income $ (student) $ (spouse) PARENTS INCOME (if applicant under 24 and unmarried) This information must be included even if you do not live with your parents Income/wages $ Child support received $ Alimony received $ Social Security $ Military housing (benefit amount) $ Other income $ TOTAL HOUSEHOLD INCOME FOR 2014 $ 3

COLLEGE EDUCATIONAL GOAL MSJC Educational Goal: A.A. Degree Certificate Transfer MAJOR Biology Computer Science Engineering Information Technology Physics Chemistry Computer Engineering Environmental Science Mathematics Science Career Goal: Expected Date of Graduation from Mt. San Jacinto College: Month Year Do you already have an Associate s Degree (A.S. or A.A.)? Yes No Are you transferring as a junior in the Fall 2015? Yes No If yes, have you applied for Admission? Yes No If yes, have you been accepted? Yes No Name of the college you plan to attend in the Fall 2015 IF NOT MSJC: 4

COMMUNITY INVOLVEMENT List on/off campus club or organizational activities to which you volunteered your assistance in the past two years. NOTE: Do not include organizations where you are employed, received compensation, or earned college credits. 1. Name of Organization Contact Person Title Phone How many volunteer hours a week do (or did) you provide? Volunteer Period Beginning Date Ending Date 2. Name of Organization Contact Person Title Phone _ How many volunteer hours a week do (or did) you provide? Volunteer Period Beginning Date Ending Date 3. Name of Organization Contact Person Title Phone _ How many volunteer hours a week do (or did) you provide? Volunteer Period Beginning Date Ending Date Student Offices Held Awards and Recognitions 5

ESSAY ADVERSITY AND CHALLENGES Responses must be typed. (Attach to your completed scholarship form) Describe any adversity or challenges you may overcome or anticipate in pursuit of your educational goals. 6

ESSAY MAJOR AND GOALS Responses must be typed. (Attach to your completed scholarship form) Describe why you selected your major area of study and your future academic and career goals. 7

List any scholarship(s) that were awarded to you for the Fall 2014 Spring 2015 academic year. 1. 2. 3. 4. 5. 6. Please do not write below this line. For Office Use Only MSJC Units Completed Total Units Completed Other Institutional Units Spring 2015 Units Cost of Attendance 2015/2016 Awarded Financial Aid for 2015/2016 $ $ Eligible for Financial Aid Yes No) If no, reason why Unmet Need: $ 8

MSJC Community Foundation Scholarship Applicant Evaluation Form To The Evaluator: Scholarship applicants must submit an Evaluation Form when applying for scholarships from at least two qualified individuals. The Evaluation form must include your name, title and contact information. The Evaluation Forms must be submitted by the applicant at the same time as they submit their scholarship application. Please return the Evaluation to the student in plenty of time for them to meet the deadline. You may also write a recommendation in letter format if you choose. _ Name of Applicant Student ID# 1. How long have you know the student and in what capacity? 2. Please rate the applicant on the following in comparison with other students of the same level: General Academic Ability Exceptional Above Below No Information Motivation and Initiative Quality of Work Willingness to Learn Imagination and Creativity Dependability/Responsibility Social Skills/Leadership Ability Potential to Succeed 3. Please provide any additional comments about the applicant below. X Evaluator s Signature Date Print Name and Title 9

MSJC Community Foundation Scholarship Applicant Evaluation Form To The Evaluator: Scholarship applicants must submit an Evaluation Form when applying for scholarships from at least two qualified individuals. The Evaluation form must include your name, title and contact information. The Evaluation Forms must be submitted by the applicant at the same time as they submit their scholarship application. Please return the Evaluation to the student in plenty of time for them to meet the deadline. You may also write a recommendation in letter format if you choose. _ Name of Applicant Student ID# 1. How long have you know the student and in what capacity? 2. Please rate the applicant on the following in comparison with other students of the same level: General Academic Ability Exceptional Above Below No Information Motivation and Initiative Quality of Work Willingness to Learn Imagination and Creativity Dependability/Responsibility Social Skills/Leadership Ability Potential to Succeed 3. Please provide any additional comments about the applicant below. X Evaluator s Signature Date Print Name and Title 10

STUDENT CERTIFICATION Financial need may be considered in determining eligibility. It must be emphasized that eligibility for scholarships is mainly based on your ability to meet scholastic and other criteria as set forth by the scholarship donors. The information you supply on your scholarship application is recognized by the college to be confidential and you agree that the college may reveal or forward the contents of your application to the MSJC Foundation committee members and/or other reviewing committees. Any disclosure of confidential information associated with any application to individuals not directly associated with the evaluation process is prohibited. Signature is required for your application to be considered. I, certify that all information given in this application and other documents is true and complete to the best of my knowledge. If asked by an authorized official of MSJC, I agree to give proof of income, which may include a copy of my (and spouse s) and/or parent s 2014 U.S. Income Tax Transcript. I also realize that any false statement or failure to give proof of income when asked may cause the denial of my scholarship application. I understand that the information requested on this application is confidential. I authorize Mt. San Jacinto College to release enrollment and financial data to scholarship donor(s). MSJC may use the information I have provided for publicity purposes. Print Name Applicant s Signature Date 11