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CITY COLLEGE OF SAN FRANCISCO
SCIENCE, TECHNOLOGY, ENGINEERING
AND MATHEMATICS (NSF-STEM)
SCHOLARSHIP APPLICATION
Spring 2012
APPLICATION SUBMISSION DEADLINE: May 18, 2012, 4:00 p.m.
NOTE: BE SURE TO COMPLY WITH DIRECTIONS ON THE FOLLOWING PAGE
Incomplete applications will not be accepted
Last Name
Return your application to:
First Name
MI
The MESA-STEM Center
Science Hall (room S142)
(415) 452-5598
Instructions for Completing Your Application
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COMPLETE THE APPLICATION CHECKLIST PAGE:
ELIGIBILITY REQUIREMENTS:
1. Cumulative GPA 2.5 with a GPA of 2.7 or better in Science, Technology, Engineering and/or Math
Courses.
2. Have completed 7 units of STEM classes at CCSF by end of Spring 2012 Semester and be enrolled in
12 units while in the scholarship program.
3. Must be a citizen or national of the United States, alien admitted to the United States for permanent
residents or alien lawfully admitted to the United States for permanent residence.
4. Have filed a FAFSA with Financial Aid.
5. Must be continuing at CCSF for the next academic year. (Fall 2012/Spring 2013)
OBTAIN TWO LETTERS OF RECOMMENDATION
Please submit two current letters of recommendation from CCSF Science, Technology, Engineering, or
Mathematics instructors who know you and are familiar with your class work and/or school and community
activities. The letters should include information that will give the STEM Scholarship Committee insight into
your personal qualities, character, special talents, academic attributes, and potential for making a contribution
to society. Do not submit more than two letters of recommendation.
NSF-STEM PERSONAL STATEMENT
Please discuss the following points in 250 to 500 words. Your format is: typed with one inch margins, top,
bottom and sides; name and ID in the top right-hand corner; Times New Roman font 12; doublespaced.
1. Discuss your education and career goals, including any degrees or certificates that you would like to
earn in Science, Technology, Engineering, or Mathematics.
2. Steps that you have already taken to reach these goals, including STEM-related work or volunteer
experience.
3. How does City College fit into your goals?
4. What has made you interested in Science, Technology, Engineering or Mathematics.
5. Any extenuating circumstances that affect your financial need. (Optional)
UNOFFICIAL TRANSCRIPTS AND COURSES IN PROGRESS
Please submit an unofficial CCSF transcript and a print-out of your current courses-in-progress for Spring
2010. You may access your transcript online at the CCSF web site. (www.ccsf.edu)
COMPLETE ADDITIONAL ATTACHMENT
Submit your Student Activity Report from the Financial Aid Office
SIGNATURE
REVIEW YOUR APPLICATION FOR COMPLETENESS
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CCSF STEM SCHOLARSHIP APPLICATION
Spring 2010
Please read all questions carefully and answer them as completely. Appearance and organization of your application will be taken into
consideration when judged by the STEM Scholarship Committee.
NAME:
Last
First
CCSF ID#:
Middle
BIRTH DATE:
CURRENT ADDRESS:
Street Address or P.O. Box
City
County
HOME PHONE:
E-MAIL: _____
State
Zip
WORK PHONE:
___________
WILL YOU AND YOUR SIBLINGS BE THE FIRST GENERATION
IN YOUR FAMILY TO GRADUATE FROM COLLEGE?
WHAT OTHER COLLEGES HAVE YOU ATTENDED?
WHAT DEGREES DID YOU EARN?
NUMBER OF UNITS COMPLETED
AT CCSF:
NUMBER OF UNITS IN PROGRESS
AT CCSF:
CUMULATIVE G.P.A. AT CCSF:
WHAT IS YOUR FIELD OF STUDY?
WHAT IS YOUR CAREER GOAL?
WHEN DO YOU EXPECT TO FINISH YOUR STUDIES
Month
Year
AT CCSF?
IF YOU PLAN TO TRANSFER TO A FOUR-YEAR COLLEGE, AT WHICH SCHOOL DO YOU INTEND TO
ENROLL?
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Last Name
AGE :
Citizenship Status
A U.S. CITIZEN, U.S.
NATIONAL OR
U.S. PERMANENT RESIDENT?
OTHER
GENDER:
First Name
TEMPORARY RESIDENT
REFUGEE/ASYLEE
STUDENT VISA
PLACE OF BIRTH:
ETHNIC BACKGROUND :
African-American
American Indian
Pacific Islander
Asian
White Non-Hispanic
Other Non-White
Filipino
Hispanic
Decline to State
DO YOU CONTRIBUTE TO THE SUPPORT OF OTHERS?
(Dependants)
IF YES, WHAT IS THEIR RELATIONSHIP?
HOUSEHOLD INCOME
My household’s annual taxable income for 2009 was:
$0 - $15,315
$25,756 - $30,975
$41,416 - $46,635
$15,316 - $20,535
$30,976 - $36,195
$46,636 - $51,855
$20,536 - $25,755
$36,196 - $41,415
over $51,856
THESE AMOUNTS NEED TO BE UPDATED BEFORE RELEASE OF APPLICATION
How many people are being supported by this income?
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Last Name
First Name
ADDITIONAL ACTIVITIES
List organizations, clubs and extra-curricular activities in which you have been active at CCSF:
List community and volunteer service:
What college, community and high school awards or commendations have you received?
Please give us any additional information that will assist us in evaluating your financial need. If
you anticipate a reduction in income, please explain.
I hereby certify that the information provided above is given freely by me and is accurate to the
best of my knowledge. I give permission to release this information to the CCSF Scholarship
Committee and its designee(s). I understand that information involving current abuse and/or
threats of violence must be reported to the Dean of Students as required by law.
SIGNATURE:
DATE:
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NOTE: All decisions of the NSF-STEM Scholarship Committee are final.