GLENDALE COMMUNITY COLLEGE
SCHOLARSHIP APPLICATION

* Required field
PERSONAL INFORMATION
How did you hear about
the Scholarship program?
*Student ID#              *Gender:   Male  Female
*Last Name:
*First Name:        Middle Initial:   
*Address:
*City:              *State:   
*Zip Code:
*Date of Birth (MM/DD/YYYY):
*Home Phone:
Cell Phone:
EMail Address:
*Residency Status: US Citizen    Permanent Resident    F-1 Student    AB 540 Student    Other
*Are you a US Veteran? Yes    No
*Re-entry student
over 25 yrs old?
Yes    No
   Last High School Attended
High School Name:
City:        State:        Country:
Year Graduated:
*Do you plan to graduate
from GCC?
Yes     No               *Month:              *Year: (YYYY)
*Do you plan to transfer
to a 4-year school?
Yes     No               *Month:              *Year: (YYYY)
*Have you applied for transfer? Yes     No
Have you been accepted? Yes     No
Name of transfer institution:
*Major:
*Career Goal:
   List by name all scholarships that you have received as a GCC student and their amounts:
 
FINANCIAL STATEMENT FOR APPLICANTS AND PARENTS
Are you presently employed?: Yes     No
*Applicant's present employment:
*Number of hours
worked per week:
*Current annual salary: $
*Savings: $
*Do you live at home
with your parents?
Yes     No
*If you live with your parents,
do you have any brothers or
sisters living at home?
Yes    No              If Yes, please list their ages:
*Do you receive financial
support from your parents?
Yes     No       * If yes, how much: $
 If Yes:
Father's annual income: $              Mother's annual income: $
*Marital status: Single    Married              If married, spouse's annual income: $
*Do you have any dependent
children living at home?
Yes     No              If Yes, please list their ages:
Are you a single parent?Yes    No
*Have you applied for
financial aid at GCC?
Yes     No
PERSONAL STATEMENT
 Please tell us why you should be considered for a scholarship (Please limit to 600 characters)
 
LEADERSHIP EXPERIENCE
 Please explain your involvement in campus or community activities and organizations as a GCC student. Include information on offices or positions held, if applicable. (Please limit to 600 characters each)
 CAMPUS ACTIVITIES:
 
 
 COMMUNITY ACTIVITIES:
 
 
Glendale Community College is in compliance with Title IX of the Education Amendments of 1972 and section 504 of the Rehabilitation Act of 1973, and is an Affirmative Action Employer. According to the Tax Reform Act of 1986 the amount of scholarship/grant not attributable to direct educational costs, i.e. tuition, books and supplies must be reported as taxable income. It is the student's responsibility to report these fund on their tax returns. Pursuant to the provisions of Public Law 93-380, as amended and appropriate section of the Education Code of the State of California, beginning with section 76200 and Title V Section 54600-54662, you are hereby authorized to release requested information from my student records maintained at your institution for scholarship purposes only.
 
Be sure to have an Instructor, Counselor or Staff member submit an online recommendation for you. Please only have one recommendation submitted. This must be submitted before the application can be processed. Please give the recommender your Student ID number.
 
Pursuant to the provisions of Public Law 93-380, as amended and appropriate section of the Educational Code of the State of California, beginning with section 76200, and Title V Section 54600-54662 , you are hereby authorized to release requested information from my student records maintained at your institution for scholarship purposes only. By submitting my application, I hereby give this permission.