EmailMe Form - 2021 ANGEL SANCHEZ, SR. 4 YR UNIV. SCHOLARSHIP

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Terms and Conditions - Please read before completing this application.

THE ANGEL SANCHEZ, SR. HIGH SCHOOL VOLUNTEER FOUR YEAR UNIVERSITY SCHOLARSHIP

*Maximum scholarship value $1000

The Volunteer Scholarship is open to high school seniors who have volunteered 25 hours to the program, intend on pursuing a degree at an accredited 4 year university, and have fulfilled the additional Scholarship Committee requirements. The scholarship is awarded based on need, volunteer performance, and academic achievement.

Requirements:

* Applicant must live in or attend a school in the Inland Empire*.
* Applicant must have accumulated a minimum of 25 volunteer hours with the Jurupa Valley Adopt a Family program in the year prior to applying.
* Applicant must be in his/her senior year in high school.
* Applicant must provide a copy of the Letter of Acceptance from the chosen post high school institution (accredited 4 year university) to the Scholarship Committee by June 1st. Checks will be issued directly to the institution on behalf of the recipient.
* Applicants must have a cumulative GPA of 3.0.

The Angel Sanchez, Sr. Youth Ambassador Scholarship
*Maximum scholarship value $2000

The Youth Ambassador Scholarship is open to high school seniors who have volunteered a minimum of 150 hours between their freshman and senior years with any non-profit and also meet the following requirements.

Requirements:

* Applicant must live in or attend a school in the Inland Empire*.
* Applicant must have accumulated a minimum of 25 volunteer hours with the Jurupa Valley Adopt a Family program in the year prior to applying (These 25 hours are part of the 150 total number of required hours).
* Applicant must apply in his/her senior year in high school.
* Applicant must provide a copy of the Letter of Acceptance from the chosen post high school institution (accredited 4 year university) to the Scholarship Committee by July 1st. Checks will be issued directly to the institution on behalf of the recipient.
* Applicants must have a cumulative GPA of 3.0.

Applications must be submitted no later than April15, 2021

FAILURE TO MEET ANY OF THE REQUIREMENTS, INCLUDING PROVIDING REQUIRED DOCUMENTATION BY THE DATES DUE WILL RESULT IN REVOCATION OF SCHOLARSHIP OFFER.

* Cities in the Inland Empire include: Banning - Beaumont - Blythe - Calimesa - Canyon Lake - Coachella - Corona - Desert Hot Sprints - Eastvale - Hemet - Indian Wells - Indio - Jurupa Valley - La Quinta - Lake Elsinore - Menifee - Moreno Valley - Murrieta - Norco - Palm Desert - Palm Springs - Perris - Rancho Mirage - Riverside - San Jacinto - Temecula - Wildomar - Adelanto - Apple Valley - Barstow - Big Bear Lake - Chino - Chino Hills - Colton - Fontana - Grand Terrace - Hesperia - Highland - Loma Linda - Montclair - Needles - Ontario - Rancho Cucamonga - Redlands - Rialto - San Bernardino - Twentynine Palms - Upland - Victorville - Yucaipa - Yucca Valley - adjoining unincorporated areas.

Scholarship Application Type *

Eligibility Checklist *

I live or attend school in the Inland Empire*

*

I volunteered 25 or more hours with the JVAAF program in 2020

*

I meet all the eligibility requirements listed in the Terms and Conditions

Personal Information

Name *

First Middle Last

Date of Birth *

MM / DD / YYYY

Place of Birth *

Email *

Phone *

### - ### - ####

Cell Phone

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Mailing Address (If Different)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Gender

Male

Female

Are you married or do receive financial support from someone other than your parents/guardians? *

Are you the primary source of financial support for any children? *

Will you be the first person in your immediate family to graduate with a four year degree? *

Citizenship

Are you currently a United States Citizen? *

If not please indicate your status? *

If you were not born an American Citizen, but are a Naturalized American Citizen, give date, place (Office or Court where Naturalization occurred) and Naturalization Number. If naturalized under the Child Citizenship Act of 2000, please include your parent(s)’ naturalization information.

Date of Naturalization (If Applicable)

MM / DD / YYYY

Place

Number

College Information

What is your planned major? *

College(s) of Interest (List up to five)

Where will you be living? *

For which term will you be seeking admission? *

High School Information

High School Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Estimated Graduation Date *

MM / DD / YYYY

Guidance Counselor's Name *

High School Phone *

### - ### - ####

Academics

You must submit a copy of your current high school transcript. The transcript must include seventh semester grades. If your transcript does not list seventh semester classes, please provide a schedule of your seventh semester classes. If chosen as a finalist you must provide an official sealed copy of your transcripts by June 1, 2021.

ACT or SAT test scores taken before January 10, 2021, must be included in the application. Photocopies or print¬outs from the SAT and/or ACT websites are acceptable. It is not necessary to send a separate sheet of test scores if they are included on your transcript.

Please upload a copy of your most recent transcripts dated January 1, 2021 or later. A copy may be mailed in (see mailing instructions below). Applications will not be reviewed until transcripts are received. All transcripts must be received by April 15, 2021.

Cumulative GPA *

Is the GPA based on weighted grades? *

Does your school rank students? *

Ranking

Your class rank
How many students in class

Does your school offer Honors courses? *

Please list any Honors Courses taken (up to 10)

Does your school offer AP courses? *

Please list any AP Courses taken (up to 10)

Does your school offer International Baccalaureate courses? *

Please list any International Baccalaureate Courses taken (up to 10)

Does your school offer an ROTC program? *

Did you participate in an ROTC program?

Highest SAT test scores

Critical Reading
Math

Date most recent SAT taken

MM / DD / YYYY

SAT Subject Test

	Test Name	Score
Test 1
Test 2
Test 3
Test 4
Test 5

Highest ACT composite score

Date most recent ACT taken

MM / DD / YYYY

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of revocation of a scholarship offer.

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution? *

Yes

No

If yes, please explain.

Have you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license (including traffic violations which resulted in a fine of $200 or more?) *

Yes

No

If yes, please explain.

Leadership and Extracurricular Activities

List your principle leadership and extracurricular activities in the order of importance to you. You may upload a separate document to list more than 9 activities.

Do you have family obligations that keep you from participating in extracurricular activities? *

No

Yes, I have to work to supplement family income.

Yes, I provide primary care for family member(s).

Activity 1

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Activity 2

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Activity 3

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Activity 4

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Activity 5

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Activity 6

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Activity 7

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Activity 8

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Activity 9

Organization
Hours Per Week
Weeks Per Year
Position Held
Responsibilities
Honors Received/Letters Earned

State the name of the organization, hours-per-week commitment, leadership role, and responsibilities held in that role. Examples include, but are not limited to, student government, publications, debate, orchestra/band, varsity athletics, church groups, performing arts, service programs, etc.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

If more than 9 activities please lists additional activities on a separate form and upload here.

Non-profit service hours - Based on the activities listed above or on your supplemental activities form please list the organization and number of hours you have donated between grades 9 and 12. This is used to summarize your volunteer hours and does not replace the activities information above. Please complete the activities section above AND the summary information included here.

	Organization	Total Hours
JV Adopt a Family Program
Non-profit 2
Non-profit 3
Non-profit 4
Non-profit 5

Award/Honors

List scholastic, extracurricular, and civic honors and awards received during grades 9 through 12. Please do not abbreviate names of awards, as we may not understand their meanings.

	Honor/Award	Grade Level
Award/Honor 1
Award/Honor 2
Award/Honor 3
Award/Honor 4
Award/Honor 5
Award/Honor 6
Award/Honor 7
Award/Honor 8

If more than 8 Awards/Honors please list on a separate form and upload here.

Family Information

Parents should assist with completing of this information.

Parent(s): Complete the financial information section based on your 2020 IRS 1040. If taxes have not been filed for 2020 please use estimates.

If parents are divorced or separated, answer the questions for the parent the applicant lived with the most in the past 12 months. If the applicant lived with both parents an equal number of days in the past 12 months, count the parent who provided the greatest amount of support, financial as well as material. Material support includes cars, clothing, medical and dental payments, etc. If that parent has remarried, the stepparent's information must be included.

With whom does the applicant live with? *

If "Other" please complete

1. Father or Legal Guardian Name *

First Last

Father or Legal Guardian Occupation *

Father or Legal Guardian Education *

2. Mother or Legal Guardian Name

First Last

Mother or Legal Guardian Occupation

Mother or Legal Guardian Education

Do you qualify for free or reduced lunch at school? *

Please indicate your family’s gross income for the most recent tax year. Include both taxed and untaxed income. *

Number of people in family, not including parents, who will receive the majority of parental support between Sept. 1, 2021, and Aug. 31, 2022. Include dependent children and others, e.g. dependent grandparent, living in household who receive more than half their support from parents. *

Number of dependent children, including applicant, as defined above, attending college during academic year 2021-2022 on at least a half-time basis. *

If you have extenuating financial circumstances, please explain in 200 words or less.

Employment

Please list any employment you have had between grades 9 and 12

Employment 1

Company
Hours Per Week
Weeks Per Year
Position Held
Responsibilities

State the name of the company, hours per week and weeks per year you worked, position held and responsibilities held in that role.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Employment 2

Company
Hours Per Week
Weeks Per Year
Position Held
Responsibilities

State the name of the company, hours per week and weeks per year you worked, position held and responsibilities held in that role.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Employment 3

Company
Hours Per Week
Weeks Per Year
Position Held
Responsibilities

State the name of the company, hours per week and weeks per year you worked, position held and responsibilities held in that role.

Grade Level

Please indicate all grade levels you participated in this activity. Hold CTRL key down to choose more than one grade.

Essay Questions

Complete the essay sections below. These essays will be used by the committee to gain a better understanding of who you are.

How has participation in the Adopt a Family program impacted your life? Maximum of 250 words. *

Briefly describe your long- and short-term goals. Maximum of 250 words. *

Optional - Pick an experience from your own life and explain how it has influenced your development. Maximum of 250 words.

Applications must be submitted no later than April 15, 2021.

By signing this application, you agree, if asked, to provide information that will verify the accuracy of your completed form. If you purposely give false or misleading information, you will be disqualified from this contest. You agree to the use of your name and information contained within the application for advertising, promotional and publicity purposes without consent or compensation.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

I understand that failure to meet any of the requirements of this application, including providing required documentation by the dates due will result in revocation of scholarship offer. *

Yes, I understand and agree to the terms listed above.

Date Time *

MM / DD / YYYY

Electronic Signature - Please place your name here. This will serve as an electronic signature verifying that you have completed this application with accurate information and that you understand the terms and conditions of the scholarship program. *

Mail Instructions

Items can be mailed in to
Jurupa Valley Adopt a Family
PO Box 3697
Riverside, CA 92519