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City of Azusa Scholarship Program

  1. Application Deadline: 5:30 pm, March 15, 2018

  2. *If you are an Adult Advancement applicant and are not currently enrolled in school, provide your most recent school.

  3. List any honors or awards you have been presented. List the title of the award, date and institution that provided the award.

  4. List all activities and years in which you have participated. Include any leadership positions held. Examples of activities include and are not limited to: clubs, sports, school publications, plays, arts, hobbies and community involvement.

  5. What are your career goals and how do you intend on achieving them.

  6. Have you been accepted? *

    If yes, please attach a copy of acceptance letter.

  7. 1. Identify a need in the community and offer a solution/plan that involves citizenship, integrity, and community involvement. 2. Tell us how you use citizenship, integrity and community involvement in your life and how you can teach these traits to others. 3. To what extent are good citizenship, integrity and community involvement needed in a community? 4. Identify an individual in your community and explain how he or she upholds citizenship, integrity and community involvement.

  8. The City of Azusa Scholarship is designed to help applicants in families with limited financial resources. Applicants must live in a household that fits the state income limits for 2017. • If you are a High School Senior applicant, provide your parent or legal guardian information. • If you are an Adult Advancement applicant and are a dependent student, provide your parent or legal guardian information. If not, continue to the Family Members section

  9. Please list all family members in your household, including yourself. Full name and relationship.

  10. Financial Information (Select One)*

    If applicant is awarded, a most recent tax return with adjusted gross income for 2017 will be required. Pay stubs alone are not an adequate form of information. Applicants must live in a household that fits the state income limits for 2017. Check the income bracket that applies to your household to certify the annual income is less than what is listed.

  11. Financial Information (Check all that apply)*

  12. I understand that misrepresentation of information subjects the applicant to being disqualified. I hereby certify that all of the above information is correct to the best of my knowledge.

  13. I, the parent or legal guardian of the applicant, understand that misrepresentation of information subjects the applicant to being disqualified. I hereby certify that all of the above information is correct to the best of my knowledge.

  14. Attach your Official Transcripts.

  15. Attach your acceptance letter.

  16. Attach your first of two reference letters required.

  17. Attach your second of two reference letters required.

  18. Attach any additional document to support your application.

  19. Leave This Blank:

  20. This field is not part of the form submission.