Sisters’ Alumni of the South Pacific
A Non-Profit Organization
833 W. Torrance Blvd Box 7-50, Torrance California 90502
Phone: (310) 835-2188
APPLICATION FORM
Please read the instructions carefully before completing this form. ATTACH EXTRA SHEETS IF
NECESSARY. Be sure to include your NAME & TELEPHONE number on each attached sheet.
You may submit your application as an attachment to: Patriciahellerud@aol.com
You must, however mail in items 2 through 4 below to our address, c/o Scholarship
Chairperson & postmarked by no later than TUESDAY, APRIL 30, 2013. NO DROPIN APPLICATIONS WILL BE ACCEPTED. LATE SUBMISSION OF ANY OF THE
REQUIRED ITEMS WILL RESULT IN AN AUTOMATIC DISQUALIFICATION OF YOUR
APPLICATION.
REQUIREMENTS:
1. Application must be typed (not handwritten) & send on-line (e-mail) or via the
US Postal service (mail).
2. Official transcripts from your previous high school or college/university.
3. Letter of acceptance from the school you plan to attend in the Fall.
4. Two (2) letters of recommendations from your teachers and/or counselors.
5. A minimum of 2.5 GPA is acceptable.
6. Answers to each of the questions #15 to #18 must be a total of 150 words or
less.
PERSONAL DATA:
Name: ____________________________________________________________________________
Address: __________________________________________________________________________
E-mail address: ____________________________________________________________________
Telephone: Home ________________ Cell____________________ Work______________________
Date of Birth:________________________ Social Security #: ________________________________
Place of Birth: ______________________Age: ___________ Sex: __________________________
Father’s Name:___________________________ Nationality: ______________________________
Mother’s Name: __________________________ Nationality: ______________________________
1. What percentage of South Pacific Islander are you? _____________________________________
(i.e. ½, ¼, etc)
2. Name your South Pacific island heritage (e.g. Samoan, Hawaiian, etc.)
_________________________
3. What is your relationship to answer #2? (e.g. father-Samoan, etc.) ________________________
4. Do you live with your parents? _____________________________________________________
If not, with whom do you live with? _________________________________________________
5 What is your connection to Southern California? (e.g. Parents live in CA, schooled in CA,
raised in CA etc.) ________________________________________________________________
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Sisters’ Alumni of the South Pacific
A Non-Profit Organization
833 W. Torrance Blvd Box 7-50 Torrance, CA 90502
Phone: 310-835-2188
ACADEMIC RECORD:
Applicants must be attending or have been accepted to an accredited College,
University or Trade Institute.
6. List the school you are currently attending or have attended:
______________________________________________________________________________
High School
City/State
Graduation Date
_______________________________________________________________________
Trade School/or Jr. College
City/State
Graduation Date
_______________________________________________________________________
University
City/State
Graduation Date
7. List the College/University/Trade School, to which you will be attending in the Fall of
2013-2014 school year.
_______________________________________________________________________
School
City/State
Graduation Date
_______________________________________________________________________
School
City/State
Graduation Date
8. What is your Major in the Fall of 2013? ____________________________________
9. List any other majors that you have had/or may pursue. _______________________
10. What academic year will you be entering in 2013-2014? ________________________
(i.e. Junior, Senior, etc)
11. How much are your tuition & fees for the 2013-2014 school
year?_________________________
12. Have you applied for any other scholarship(s)?
_____________________________________
13.
Scholarship Name(s):
_____________________________________
Amount Awarded (if any):
__________________________________
14. Will you be working while in School? __________Hours? ________________________
** Reminder: Once accepted as a recipient of this organization, it is your responsibility
to inform the Scholarship Chairperson, within 5 days, either by e-mail or telephone of
any changes in your school plans, your school, including the financial aid office address,
your address, telephone (contact) number or e-mail address. **
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Sisters’ Alumni of the South Pacific
A Non-Profit Organization
833 W. Torrance Blvd Box 7-50 Torrance, CA 90502
Phone: 310-835-2188
ACADEMIC STATEMENT: These two parts of the application are critical to your evaluation
to be a recipient. Be thorough and complete with your answers.
Write a brief statement (150 words or less for each of the questions below) explaining your
interest in the field of study you have chosen to pursue:
15. Why did you decide on this particular field of study?
16. What are your experiences in this field (if any)?
17. After obtaining your degree, how do you plan to use it?
EXTRACURRICULAR ACTIVITIES:
18. Describe your extracurricular activities, community and/or school involvement,
organization membership, interests, hobbies, talents, sports etc.
When awarded a scholarship, I pledge to inform and send confirmation of enrollment and forward an
official transcript by January 31, 2014. I acknowledge that if I do not forward an official transcript, I
will not be eligible to apply for the 2014-2015 academic year.
I hereby submit this application in good faith and assure that all information submitted is true and
correct.
________________________________________
Signature
_____________________________
Date
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