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Liberty high School 2016-2017

Local Scholarship application

Applications must be turned into the College & Career Center

on or before Friday, January 27, 2017 @ 4pm. Applications turned in after the deadline date or incomplete applications will not be considered.

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Liberty High School

Scholarship Instructions

Please read through all the instructions prior to completing.

1. Application:

a. Application should be completed to the best of your knowledge. All areas are

required unless noted as optional.

2. Scholarship Selection List:

a. Click to fill in the box next to each scholarship that you qualify for on pages 8 & 9.

Choose as many as you are eligible for. See Criteria Document for full description,

eligibility requirements and essays if applicable.

3. Be sure to include a copy of your FAFSA Confirmation page showing your EFC with your

completed packet.

4. Essays:

a. Are noted next to the scholarship list in the full description document. (Criteria

Document)

b. Full name of student and scholarship name, should be clearly marked on all pages

of each essay in the top right hand side of the page.

5. Resume/Activity Sheet:

a. Include a list of your High School achievements, Clubs, Sports and all other

activities that you have done for the past 3 years. (Please see example in the

Career Center or Career Center Webpage for ideas.)

In addition to this application, please attach the following items for each scholarship

you are applying for:

1. 3 Evaluations (2 from staff members, 1 from community member)

2. Personal statement (1 page double spaced)

3. FAFSA Confirmation Page with EFC

4. Transcript (unofficial)

5. Activity Sheet/Resume (See example in Career Center or Career Center Webpage)

6. Additional essays

a. BOTH Committee Scholarship Packets should have ALL Essays (Personal

Statement, Supplemental Essay if required & One Copy of Each DONOR Essay

Written) & Committee Scholarship Checklist

b. Each Donor Scholarship Packet should only include the Personal Statement &

Specific Scholarship Essay if required.

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Liberty High School

2017 Scholarship Application

Scholarship Packet: Committee ______ Donor ________

Name of Scholarship if Donor Packet: ___________________________________________________ (Please leave this line blank & fill in the name of the scholarship after you make

copies)

Name of Student: ____________________________________________ ID#:_______________

Student’s Information:

Address: ___________________________________________________________________________

City: _______________________________ State____________ Zip:_________________

Home phone (____) _________________ Cell phone (____) ___________________________

Email Address: ________________________________________________________________

Are you currently working? ________ If yes, how many hours per week? ______________

Company’s Name: ________________________________________________________________

If employed is anyone dependent on your present income? _____ Yes _____ No

Do you plan on working while attending college? ________ How many hours? ________

Have you applied for the Free Application for Federal Student Aid (FAFSA)? _____ Yes _____ No

If yes, Please attach FAFSA Confirmation page.

If no, why not? ____________________________________________________________

Please list any other financial support you may receive (scholarships, grants and savings) towards your

post high educational expenses:

________________________________________________________________________________

Optional Information:

1. U.S. Citizen Permanent Resident Alien Resident

2. Mark your ethnic background: _____Caucasian ____African-American _____Hispanic Filipino

Pacific Islander_ Asian American Indian Eastern Indian Other:

3. Please list any organizations or clubs in which your parents are members. (i.e.: Kiwanis,

Rotary, Lions, American Legion)

4. Are you first generation college student? _____ Yes _____ No (If either of your parents has not attended college, then you are considered first generation)

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Parent’s Information: Student Name: _______________

1. Parents’ current marital status:

Single _____Married Separated Divorced Widowed

With whom do you live?

Name of Parent or Guardian #1:___________________________________________________

Name of Parent or Guardian #2:___________________________________________________

Parent or Guardian #1’s Occupation: _______________________________________________

Parent or Guardian #2’s Occupation: _______________________________________________

List all family members in your household include your parents, (if you live with them) yourself, your

siblings, and anyone supported by your parents and indicate current status:

Name Current Grade Employed Continuing Education

Indicate grade yes/no where

OPTIONAL: Annual Net (after taxes) family income

(Please check the range that applies.)

____$0-10,000 ____$11,000-19,999 ____$20,000-29,999 ____$30,000-39,999

____$40,000-49,999 ____$50,000-69,999 ____$70,000-99,999 ____ Over $100,000

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Student Name: __________________

Note any extenuating circumstances which may have burdened the family financially:

List colleges/universities, which you have applied to:

College Name City State Total Annual Cost Accepted (Y/N)

What is your planned major? _________________________________________________________

What are your career objectives?

___________________________________________________________________________________

___________________________________________________________________________________

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Supplemental Criteria Student Name: __________________

The following information will be used by the committee to determine which scholarships you

may be eligible to receive. Please read the list carefully and answer the questions to the best of your

ability.

1. Did you participate in the Liberty High School Music, Drama or Performing Arts Program? __Yes __No

2. Did you participate in the Liberty High School Rally Squad? Yes, # of years __

3. Did you participate in the Liberty High School Dance Team? Yes, # of years __

4. Are either of your parents a member of:

Liberty Education Association (LEA) ____Yes, site ___________ or _____ No

California School Employee Association? (CSEA) _____Yes, site or No

5. Have you played a varsity sport at Liberty High School? Yes or No

6. Have you ever been a Rotary Student of the Quarter?

___ Yes, QTR Year or No

6a.Have you ever been or are you an officer of the Interact Club?

____Yes, office ______________________ Year ____ ___ No

7. LHS Academy: PADA (Public Art & Design Academy) BTA (Business Technology Academy)

HCA (Health Careers Academy) TLC (Teaching & Learning Careers Academy)

8. CTE Pathways: _______Ag & Natural Resources _______Applied Technology

_______Building Trades & Construction _______Business & Finance

_______Hospitality, Tourism, & Rec _______Information & Communication Tech

_______Transportation

9. List all LOCAL schools that you attended; elementary through 8th grade.(Please list grades you

attended each school) (i.e.: Edna Hill - 6th – 7th grade)

Elementary School Middle School

Elementary School Middle School

LHS Scholarship Essay(s)

Everyone MUST submit the required Personal Statement outlined below.

All essays should be typed and double spaced. Student Name, ID Number and

Scholarship Name should be in Upper Right Corner of Essay

Required Personal Statement

ALL applicants must submit a one-page essay (typed & double spaced) stating your goals and

how your activities have made or will help you obtain this goal. Please also indicate other

information about yourself not described above that will also be of help to both the Scholarship

Committee and Donors for selection.

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Signature Page:

I certify that all the information presented in this scholarship application is true and correct to

the best of my knowledge. I understand that providing false information or misleading

information will result in disqualification from the scholarship competition. I understand this

information is confidential except for the purpose of scholarship applications.

Authority to release educational information: LHS is granted permission to release educational information (application, transcript, attendance

and teacher evaluations) to organizations for the purpose of applying for a scholarship.

Scholarship Acknowledgement: Scholarships are subject to change at any time. Scholarships can be retracted at any point up

until the scholarship awards night.

Student Signature __________________________________ Date _______________

Parent Signature ___________________________________ Date _______________

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LHS Scholarship Committee Scholarships – Two Packets Turned in

Complete packets will Include: 1. Completed Application Student Name: ___________________ 2. Personal Statement

3. 3 Student Reports 4. Transcript

5. FAFSA Confirmation Page 6. Activity Sheet/Resume 7. THIS Committee Scholarship Checklist

8. Supplemental Essay if required By Committee Scholarship

9. One Copy of Each DONOR Essay Written (If Applicable)

□ Mildred Ballard Memorial □ LHS Class of 1991 & 1994

□ Brentwood Art Society □ LHS Class of 1996

□ Brentwood Chamber of Commerce □ LHS Class of 1999

□ Brentwood Dentistry Dental Group □ LHS Class of 2006

□ Brentwood Lions Club Charles Weeks Ag Award □ LHS Class of 2007

□ Brentwood Lions Club Pat Callaghan Science Award □ LHS Class of 2010

□ Brentwood Men's Club Sebastian Ourthiage Memorial □ LHS Class of 2012

□ Brentwood Pal □ LHS Scholarship Committee

□ Brentwood Press □ LHS Science & Technology Award

□ Kevin Carpenter Memorial □ LUHSD Memorial Fund

□ College & Career Center □ Local Eyes Media Group

□ Sandra Crawford Early Childhood Education □ M.A.P. Service Award

□ CSEA Liberty Chapter #238 □ Dr. Sloan McDonald and Dr. Roberto Deloso

□ Delta Advocacy Foundation Bob Smith Memorial □ Tom Milan Memorial

□ Delta Informal Gardener's □ Oakley Women's Club

□ Merse DeVera Memorial Sports □ Elin Ovick Memorial

□ E.A.P. Business □ Yolanda Pena-Mendrek

□ Graves' Brothers Memorial □ Herb Scott Memorial

□ Darren R. Hansen □ Simoni & Massoni Family Memorial

□ LEA-Liberty Education Association □ Coach Taylor Memorial Baseball

□ LHS Class of 1978 □ Kane C. Thompson Memorial

□ LHS Class of 1986

□ LHS Class of 1989 & 1993

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LHS Donor Scholarships – One Packet for EACH Scholarship Applied

Complete packets will Include: 1. Completed Application Student Name: ___________________

2. Personal Statement 3. 3 Student Reports

4. Transcript 5. FAFSA Confirmation Page

6. Activity Sheet/Resume 7. Supplemental Essay if required □ John, Evelyn & Tiny Bettencourt Agriculture Scholarship □ Knightsen CSEA Chapter

□ Ernie M. Borbon Memorial □ Knightsen Opportunity

□ Brentwood Elementary Parents Club □ Knightsen Parent-Teacher Club

□ Brentwood Teachers Association □ Alecia Lamport Memorial

□ Brentwood Women's Nine Tees □ LHS Athletic Booster Award

□ Brentwood Rotary Club □ LHS Dance Team

□ Bright Future □ LHS Latinos Unidos Club

□ William B. Bristow □ LHS Mr. Liberty Scholarship

□ Broadway Under The Stars □ LHS Parents Club

□ Byron Union Teacher's Association □ LHS Wrestling

□ Nick Castle Memorial □ LHS Yearbook Scholarship

□ Carl B. Casey Memorial Scholarship □ Jerry Lilley Memorial Athletic

□ Edward and Elizabeth Conner Foundation □ Russell Allen Lockwood for Progression

□ Blachman Decker Family "Get Real" Memorial □ Sgt. Scott Lunger Memorial Scholarship

□ Delta Wrestling □ Dennis Main Memorial

□ Discovery Bay Lions Club □ Carmelita Maxey Memorial

□ Discovery Bay Elementary PTA □ Isaac Montanez Family

□ EDYSL East Diablo Youth Soccer League □ Ron Nunn KC Club Scholarship

□ Excelsior PTSA □ PADA Scholarship

□ Fancey Family Scholarship □ Todd Anthony Perea Film & Digital Media

□ FEA Future Educators of America □ Ivy Richardson Scholarship

□ Beatrice Foster Memorial □ Kayla Shepard Giving Back Memorial

□ Future Innovators □ Stuart Music

□ Garin School Alumni □ Jonathan, Jake & Jordan Tickner Family

□ Olga Ghilarducci Memorial □ Dr. Val Tompkins & Friends Scholarship

□ John Allen Hancock Memorial Wrestling □ Volunteer Parents of the Arts Club

□ Jones-Sarmento Family Music Appreciation Award □ Ben Whitener "Reach for the Sky"

□ Knightsen Community □ William H. Connor Scholarship

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Student Report: Students please print a TOTAL of 3 reports, 2 MUST be from Teachers.

Applicant’s Name:

Educational and Career Goal:

Teacher’s Name given to:

The above student is an applicant for a scholarship. To assist the Scholarship Committee in it’s appraisal of the applicant,

your cooperation is requested in providing the following evaluation:

Please explain your answer to question

5:

6. Personal rating of the applicant:

CHARACTERISTICS BELOW AVERAGE AVERAGE GOOD OUTSTANDING

Please comment on any information you have which may help the committee make a wise choice. Include information

About motivation, financial need, goals,

etc.:

TEACHERS: Please complete this form to assist in providing a deeper understanding of the

student and return to the student. They will include it in their packet.

QUESTIONS YES NO NO COMMENT N/A

1. Has the applicant maintained at all times a definite and sincere interest in

his/her studies?

2. Has the applicant been an active leader in some classroom or extra-curricular

activity under your supervision?

3. Did the extra-curricular activities interfere with the applicant’s studies?

4. Do you recommend the applicant for a scholarship?

5. Do you think the applicant will be successful in college?

INTELLIGENCE

PERSONALITY

LEADERSHIP

CITIZENSHIP

EFFORT

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Student Report: Students please print a TOTAL of 3 reports, 2 MUST be from Teachers.

Applicant’s Name:

Educational and Career Goal:

Teacher’s Name given to:

The above student is an applicant for a scholarship. To assist the Scholarship Committee in it’s appraisal of the applicant,

your cooperation is requested in providing the following evaluation:

Please explain your answer to question

5:

6. Personal rating of the applicant:

CHARACTERISTICS BELOW AVERAGE AVERAGE GOOD OUTSTANDING

Please comment on any information you have which may help the committee make a wise choice. Include information

About motivation, financial need, goals,

etc.:

TEACHERS: Please complete this form to assist in providing a deeper understanding of the

student and return to the student. They will include it in their packet.

QUESTIONS YES NO NO COMMENT N/A

1. Has the applicant maintained at all times a definite and sincere interest in

his/her studies?

2. Has the applicant been an active leader in some classroom or extra-curricular

activity under your supervision?

3. Did the extra-curricular activities interfere with the applicant’s studies?

4. Do you recommend the applicant for a scholarship?

5. Do you think the applicant will be successful in college?

INTELLIGENCE

PERSONALITY

LEADERSHIP

CITIZENSHIP

EFFORT

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Student Report: Students please print a TOTAL of 3 reports, 2 MUST be from Teachers.

Applicant’s Name:

Educational and Career Goal:

Teacher’s Name given to:

The above student is an applicant for a scholarship. To assist the Scholarship Committee in it’s appraisal of the applicant,

your cooperation is requested in providing the following evaluation:

Please explain your answer to question

5:

6. Personal rating of the applicant:

CHARACTERISTICS BELOW AVERAGE AVERAGE GOOD OUTSTANDING

Please comment on any information you have which may help the committee make a wise choice. Include information

About motivation, financial need, goals,

etc.:

TEACHERS: Please complete this form to assist in providing a deeper understanding of the

student and return to the student. They will include it in their packet.

QUESTIONS YES NO NO COMMENT N/A

1. Has the applicant maintained at all times a definite and sincere interest in

his/her studies?

2. Has the applicant been an active leader in some classroom or extra-curricular

activity under your supervision?

3. Did the extra-curricular activities interfere with the applicant’s studies?

4. Do you recommend the applicant for a scholarship?

5. Do you think the applicant will be successful in college?

INTELLIGENCE

PERSONALITY

LEADERSHIP

CITIZENSHIP

EFFORT