Hilltop High School

Dollars for Scholars

Scholarship Application

1) Personal Info: Student Name: ________________________________________________________________

Address: ________________________________________________________________

Email Address & Phone Number: ________________________________________________________________

Parent (or Guardian) Name(s): ________________________________________________________________

2) Eligibility Information: (check one) (see http://www.oocities.org/hhsdfs/Eligibility.rtf for full info)

__ CSF Member (or eligible): ___ Life Member ___ CSF Member for at least 3 semesters

__ Not a member of CSF, or eligible less than three semesters (attach teacher recommendation (required))

__ Other eligibility: __ Art scholarship __ Other: ________________________________

3) College Intentions: (indicate at least one, attach additional page if necessary)

__ Southwestern College __ Other junior college - specify: * ________________________

__ S. D. State University (SDSU) * __ Other Cal State College/Univ: * ________________________

__ UC San Diego (UCSD) * __ Other UC or private college: * ________________________

Preferred consideration will be given to planned attendees of Southwestern College or Dollars for Scholars

Collegiate Partner colleges (see http://www.californiadollarsforscholars.org/partners.htm)

Attach copy of acceptance letter(s) from indicated college(s).

4) Academic Information:

GPA–Unweighted/Weighted: _____/_____ Test Scores - SAT (Verbal/Math): _____/_____ ACT: _____

5) Other scholarships that I know that I will be receiving (name and amount of each, and total):

_______________________________________________________________________________________________

6) Why should HHSDFS give you a scholarship (briefly)?: _____________________________________________

_______________________________________________________________________________________________

7) Writing sample – “Thank You Letter”

All the funds for the scholarship(s) that will be awarded this year came from donations from individuals and businesses who wanted to help young people attend college and achieve their long-term personal potential. All funds were raised by efforts of parent, student, and counselor volunteers.

If you had the opportunity to express your appreciation to the person(s) and/or organization(s) whose donations made your scholarship possible, what would you like to say to them?

IMPORTANT: Write your statement in the form of a letter (typewritten preferred) on a separate sheet.

8) Applicant statement (signature required):

I am a graduating senior at Hilltop High School. The information furnished above is accurate, complete, and correct as of the date of this application. I understand that all information provided is subject to verification, any incorrect information is grounds for disqualification of this scholarship application, and authorize school representatives to verify the above information. Award of scholarship is contingent on attendance at indicated college.

I understand that publicity is a key ingredient in raising community awareness of Dollars for Scholars and raising funds for scholarships, and that community awareness of the student(s) receiving scholarships is important. Therefore, if awarded a scholarship, I agree to provide a photograph of myself. I also agree to public disclosure of my First Name, Last Name, HHS graduation year, and intended College. I also consent to release of my statement of appreciation to donors who made my scholarship possible. I also agree to consider possible interviews from newspaper or other media, or other publicity as notified by HHSDFS (i.e. not required).

_____________________________ Date: __________ _____________________________ Date: __________

Student Parent / Guardian

Website: www.oocities.org/hhsdfs To re-print a blank form: http://www.oocities.org/hhsdfs/Application_2005