Title
Mr. Ms. Mrs.
Name
Local Address
Address 1
Address 2
City
State or Province
ZIP
Permanent Address
Is this your parents’ address?
Yes No
Home Phone
E-mail Address
Date of Birth
MM DD YY
Gender
Male Female
High School
Address
State
High School Graduation Date
MM YY
Father’s Highest Level of Education Completed
High School Diploma Associate Degree Bachelor’s Degree Master’s Degree Professional Degree (J.D., M.B.A., D.D.S., M.D., etc.) Doctoral Degree
IUB Campus
Mother’s Highest Level of Education Completed
Number of Total Credits Earned
Number of Credits Registered for Fall 2008 Semester
Major
Cumulative GPA
Current Employment
Business Name
Length of Employment
Community Service or Involvement
Current Past
Name of organization
City and state
Dates of involvement
Briefly describe capacity of involvement:
ESSAY #1 (no more than two typed, double-spaced pages) Write an essay describing your current goals as well as your goals after graduation. You can include both career and personal goals in your essay. If you are currently taking steps toward achieving your goals, explain those. You can include any other information that you believe will help the committee understand why you are a good fit for this award.
ESSAY #2 (no more than two typed, double-spaced pages) Write an essay describing the circumstances that led up to the beginning of your college education. For example, was there someone in particular who served as a mentor for you, any obstacles you had to overcome, or other things that influenced your decision to attend college and/or choose your particular major or career path?
Certification:
By signing this certification, I allow the Latino Alumni Association ("LAA") access to my educational records to verify information submitted in this application.
I will use any fellowship assistance only for payment of required fees, room and board, books and supplies, and related educational expenses.
I will notify the LAA of any financial support not listed on this application when I am notified of the award.
I certify that the above information is true and correct. I understand that if I knowingly make a false statement on this application, I will be liable for any funds received.
I acknowledge that the name of the successful candidate will be shared with the donors and if I am chosen as a recipient of the scholarship, I expressly authorize the LAA to release my name and photo for publicity purposes.
IU student ID number:
Today’s Date: Month Day Year
*Before you submit this application, please make sure all fields have been completed.
