請注意
亞裔及太平洋群島裔學生
三藩市市立大學亞裔教員聯盟於二零一六年將提供
二十名五百圓獎學金及五名一千圓獎學金*
以鼓勵現就讀三藩市市立大學之學生
(*一個護士獎, 一個轉校升學獎, 三個普通獎)
申請資格﹕
申請千圓大獎額外資格﹕
 學業及就業目標
(一個護士獎, 一個轉校升學獎, 三個普通獎)
 經濟需要
 轉校升學獎, 須遞交一份四年制大學的錄取信.
 有潛在的領導能力
如尚未收到, 須於面試時提交
 有為學校及社區服務精神
 社區機構推薦書 (請用機構抬頭信紙),包括﹕
 在美國還沒有獲取學士學位或更高學歷
1. 機構介紹
 非正式大學成績單
2. 申請人擔任之角色和怎樣幫助此機構
 教師或顧問推薦（需要兩人,
3. 何時在此機構工作, 工作多久及工作時間
至少一人是市立大學教師.
4. 申請人對此機構之貢獻
需要填寫正式的表格,
附加的信件可接受但是不能代替正式表格）
申請表格可在以下地方索取﹕
- Ocean 總校獎學金辦公室MUB 130B 室
- 上網索取: http://www.ac-scholarship.com
- 護士學系辦公室 (Cloud 340, Ocean)
- 各分校顧問室
申請截止時間﹕二零一六年三月四日
星期五, 中午十二時正
將填好的申請表, 附帶資料及推荐信一式三份郵寄或交到
AC Scholarship Committee Co-Chairs
Daniel Van
CCSF Chinatown/North Beach Center
808 Kearny Street, Room 103
San Francisco, CA 94108
chvan@ccsf.edu
415-295-8603
或
Andrew Hom
City College of San Francisco
50 Phelan Ave., Batmale Hall 378(L378)
San Francisco, CA 94112
anhom@ccsf.edu
注意﹕非學分學生和留學生都可以申請, 以前獲獎者不能再申請. 市立大學獎學金申請表不能代替此獎學金申請表.
入選 的申請人暫定於4/8/16 or 4/9/16接受面試.
市立大學亞裔聯盟獎學金申請表
page 1 of 4
AC SCHOLARSHIP APPLICATION
(Please submit application and two (2) Instructor/Counselor Recommendation Forms* in TRIPLICATE)
*At least one of the two recommendations must be from a CCSF instructor
請提交一式三份的申請表, 附帶資料及兩封推荐信(其中一封必需由市立大學教師填寫)
Name姓名 : _________________________________________________________ Student ID#學生証號碼: _________________
Last (print legibly)
First
Middle
Address地址: ______________________________________________________________________________________________
Number (print legibly)
Street
Apt.
_______________________________________________________Phone :(_______) ________________________
City
State
Zip
(Area code)
Cell Phone手機號碼:(________)_____________________E-mail Address電郵地址: ____________________________________
(Area code)
Gender性別: Male
Female
Birth Place出生地: ____________________________________________________
City
Country
Major主修專業: ____________________ Cumulative GPA總平均分數: ____________ (Subject to Administrative Verification)
Campus(es) Currently Enrolled in上課地點: (1)________________________________ (2)________________________________
Class/Crse#______________ Instructor_________________________________
課程
老師
Class/Crse#______________ Instructor _________________________________
Class/Crse#______________ Instructor _________________________________
Class/Crse#______________ Instructor _________________________________
Class/Crse#______________ Instructor _________________________________
Class/Crse#______________ Instructor _________________________________
If you are studying non-credit beginning levels of English i.e. ESL Lit, Levels 1, 2, 3, or 4, you may write your response to the following
questions in your native language. All other students must write in English. 非學分英文字母班至第四班學生可用母語填寫,.
其他學生必須用英文填寫
SCHOOL/COMMUNITY ACTIVITIES: What school or community activities, clubs, or organizations have you participated in within
the last three years? (You may include activities in your home country.) What role(s) have you taken? What is your plan to improve the
life of the Asian Community? (Answer this question in no more than 250 words. 不超過二百五十字)
列出你在學校，社區團體的活動(三年內本地或外地均可), 你計劃如何改善亞裔社區?
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page 2 of 4
Describe your academic and career goals. How did you decide upon them? How do you plan to achieve them? What might be your
special challenges or obstacles? Please be sure to tell us about your need for financial aid. Show your strengths and leadership skills.
(Answer this question in no more than 250 words. 不超過二百五十字)
描述你的學業及職業目標. 為何作出這些選擇, 打算如何達到這些目標及應對可能遇到的挑戰和困難?
展示你的專長及領導才能.
請記得寫下你對助學金的需求
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Additional information may be attached on a separate sheet of paper. 如有需要可多加一頁紙.
I hereby state that the information on this application is correct. 我聲明申請表中所填的資料是正確的.
Signature簽名 _______________________________________ Date日期_________________
page 3 of 4
Asian Coalition Instructor/Counselor Recommendation Form
(Note to the applicant: Two (2) recommendations are required: at least one must be from a CCSF instructor)
Dear Instructor/Counselor,
Your student, ____________________________ in ___________(course #) has applied for an Asian Coalition
Scholarship. Please address the following criteria:
(low)
(medium)
(outstanding)
Academic Progress
(
)
(
)
(
)
(not observed)
(
)
Classroom Participation
(
)
(
)
(
)
(
)
Commitment to Career Goals
(
)
(
)
(
)
(
)
Cooperative Spirit
(
)
(
)
(
)
(
)
Creativity
(
)
(
)
(
)
(
)
Participation in Outside Community
(
)
(
)
(
)
(
)
Potential Leadership Skills
(
)
(
)
(
)
(
)
Volunteer Activities
(
)
(
)
(
)
(
)
Why do you feel this student is deserving of a scholarship award?
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__________________________________________________________________________________________________________________________ __________
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Signature: __________________________________Campus/Mailbox#:______________/_______ Date: _________
Print Name: _________________________________Dept./Title:____________________Phone:_________________
Email Address: ______________________________
Please complete this form and return it to the applicant. Applicant is required to submit this form along with the Asian
Coalition Scholarship application, as this recommendation will be considered with the student’s application in the
screening process. Thank you for your assistance.
page 4 of 4
Asian Coalition Instructor/Counselor Recommendation Form
(Note to the applicant: Two (2) recommendations are required: at least one must be from a CCSF instructor)
Dear Instructor/Counselor,
Your student, ____________________________ in ___________(course #) has applied for an Asian Coalition
Scholarship. Please address the following criteria:
(low)
(medium)
(outstanding)
Academic Progress
(
)
(
)
(
)
(not observed)
(
)
Classroom Participation
(
)
(
)
(
)
(
)
Commitment to Career Goals
(
)
(
)
(
)
(
)
Cooperative Spirit
(
)
(
)
(
)
(
)
Creativity
(
)
(
)
(
)
(
)
Participation in Outside Community
(
)
(
)
(
)
(
)
Potential Leadership Skills
(
)
(
)
(
)
(
)
Volunteer Activities
(
)
(
)
(
)
(
)
Why do you feel this student is deserving of a scholarship award?
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
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____________________________________________________________________________________________________________________________________
Signature: __________________________________Campus/Mailbox#:______________/_______ Date: _________
Print Name:_________________________________Dept./Title:____________________Phone:_________________
Email Address: ______________________________
Please complete this form and return it to the applicant. Applicant is required to submit this form along with the Asian
Coalition Scholarship application, as this recommendation will be considered with the student’s application in the screening
process. Thank you for your assistance.