VENTURA COUNTY COMMUNITY FOUNDATION
2006 SCHOLARSHIP APPLICATION INSTRUCTIONS
REQUIREMENTS: (Assemble each application in the following order & check when completed)
Complete the following Application Form. (PRINT CLEARLY OR TYPE)
Complete the Important Privacy Notice for Consumers form with signatures & dates.
Complete the Financial Aid Questionnaire if the scholarship you are applying for requires demonstration
of financial need.
Provide an official copy of your school transcript. If you are applying for more than one scholarship,
request two copies. You may then make copies of one transcript for additional applications, but you must
provide one sealed official copy.
Provide two letters of recommendation, one from current faculty and one from faculty or another person
(not a relative) who can attest to your achievements, character, and promise. They must sign (INCLUDE
THEIR TITLE OR RELATIONSHIP TO YOU) and date the recommendation letter (MUST BE WITHIN THE
LAST 6 MONTHS). Please note that some scholarships require additional letters of recommendation.
Check each guideline carefully and follow directions.
Write one essay of 1,000 words or less that relates what is important in your life and helps us know you
better as a person and a student. This can be done by describing yourself, evaluating a significant
experience or achievement in your life, or by explaining your hopes for the future. You should also explain
why you have selected your proposed course of study and how you will achieve your goals for your course
of study/ career. Read the guidelines for each scholarship carefully as some request specific essay topics.
Do not write different essays if you are applying for more than one scholarship, but address any specific
topics required by various scholarships within a single essay.
Double check you have met ALL eligibility requirements for the particular scholarship(s) you have
chosen to apply for. If you are applying for more than one scholarship (you may apply for up to 5 different
VCCF scholarships) photocopy (single sided) the completed application, required attachments and essay
for each scholarship to which you are applying. You must have one complete application package for
each scholarship. On page I of each application package, check the box next to the title of the
scholarship opportunity for which the packet is intended. Check only one box per application as each
application will be processed separately.
CLIP ALL ITEMS TOGETHER IN ONE PACKAGE - DO NOT STAPLE ANYWHERE IN PACKET.
USE A PAPER CLIP. DO NOT HAVE ANY LETTERS OR TRANSCRIPTS SENT DIRECTLY TO THE
FOUNDATION. THEY MUST BE INCLUDED IN YOUR PACKET.
Send or Deliver to:
Scholarships – VCCF (Ventura County Community Foundation)
1317 Del Norte Road, Suite 150
Camarillo, CA 93010-8504
Applications must be received in VCCF’s office before 5:00 p.m. on February 17th, 2006.
(Postmarked on Feb. 17th is NOT acceptable.)
No faxes, emails, late, or incomplete applications will be accepted. NO EXCEPTIONS!
VENTURA COUNTY COMMUNITY FOUNDATION
2006 SCHOLARSHIP APPLICATION - PAGE 1
Name
Last
First
M.I.
Phone
City
State
Zip
Last Four Digits of Your
Social Security Number
Address
Number & Street
Age
Sex
Email
I have resided in Ventura County since (month/year)
Parent(s) or Guardian
Name(s)
Phone
Re-Applying for (name of Scholarship):
Year Previously Received:
*Re-applications require this Application Form, Financial Aid form (if required), Official College Transcript, essay, letters of recommendation dated
within past six months, and most recent listing of extracurricular school and/or community activities and/or work experience.
Please list here all the (up to 5 total) VCCF scholarship(s) you are applying for. Read individual scholarship instructions before
applying. If you list more than one scholarship opportunity, make sure you send a full packet for each application. Check off one
scholarship name for each complete package, as each one will be processed separately. (GSP counts as 1 application)
1.
2.
3.
4.
5.
What high school will you graduate or have you graduated from?
Name of School and City
Dates Attended
Other Secondary School(s) attended
Name of School and City
High School Graduation Date
Dates Attended
GPA
If currently attending college, provide the following:
Name of School & City, State
College GPA:
Start Date
I am a College (check one): ___freshman ___sophomore ___junior
___senior
College/University/Trade School you plan to attend, or that you have applied to (list in order of preference):
(Circle the schools that you have been accepted to so far.)
Expected course of study or college major:
Test Scores (as applicable) SAT: Total
ACT
AP Exams
Math
Critical Reading
Writing
VENTURA COUNTY COMMUNITY FOUNDATION
2006 SCHOLARSHIP APPLICATION - PAGE 2
Applicant Name:
Some of our scholarships ask for specific information; complete this section if required per Guidelines.
Circle Yes or No and Fill in Blanks Where Appropriate:
1. Y/ N Have one or both of your parents been killed or disabled while actively engaged in law enforcement service or
public service as a fire fighter?
2. Y/ N Are you physically or visually impaired or otherwise disabled? Please explain:
3. Y/ N Are you related by blood or marriage to a member of Calavo Growers of California and from one of Calavo’s
twelve districts? State the name and relationship:
4. Y/ N Are one or both of your parents an employee or contractor of Finch Ranches? State their name(s) and affiliation:
5. Y/ N Are you the child of an agricultural worker? Who is your parent’s employer and where does your parent work?
6. Y/ N Are you an ethnic minority? Please circle: African-American, Asian, Hispanic/ Latino, Native American, or
Other (please specify):
7. Y/ N Are you an employee, or the son, or daughter, or legal ward of an employee of Saticoy Lemon Association? If so,
write employee’s name and your relationship to the person employed by Saticoy Lemon Association here:
8. Y/ N Do you have a relationship to a member of the Saticoy Poinsettia Club? If so, state the name and relationship:
9.
Y/ N Are you a single parent? (You may be required to provide documentation of parental status)
10. Y/ N Are you the first member in your family to attend college?
VENTURA COUNTY COMMUNITY FOUNDATION
2006 SCHOLARSHIP APPLICATION - PAGE 3
Applicant Name: _____________________________________________________________________________________
NOTE: Please use only the space provided here to list your school, community, volunteer, and/or work
experience. Do not attach any additional items. Be sure to include start and end dates of involvement for
school and community activities, and indicate hours spent per week and weeks per year. Type or print clearly.
School Activities: List the extracurricular school activities in which you have participated during the last four years. Please list
activities in order of importance to you.
Activity
Description/ leadership positions /awards received
Dates of Involvement
Hours Per Week/Wks Per Year
Community Activities: List the community, volunteer and/or religious activities in which you have participated during the last four
years. Please list activities in order of importance to you.
Activity
Description/ leadership positions /awards received
Dates of Involvement
Hours Per Week/Wks Per Year
Work Experience: List any paid work experience you had during the past four years, beginning with your most recent position.
Name of Company
Description of work
Dates of employment
Hours Per Week/Wks Per Year
Applicant Signature: I attest that all of the preceding statements in this application are true.
Name_______________________________________________________________Date _____________________________
2006 SCHOLARSHIP APPLICATION – PAGE 4
Important Privacy Notice for Consumers
You have the right to control whether we share some of your personal information. Please
read the following information carefully before you make your choices below.
Your Rights
You have the following rights to restrict the sharing of personal and financial information with our
Scholarship Committee, which is comprised of independent volunteers from the community. Nothing in this
form prohibits the sharing of information necessary for us to follow the law, as permitted by law.
Your Consent
By signing this document below, you hereby grant permission to the Ventura County Community
Foundation (VCCF) to share and disclose personal and financial information with the members of our
Scholarship Committee. If the applicant is under 24 years of age, both the applicant and parent/legal
guardian must sign this form.
Your consent will remain in effect until revoked or modified by you. You may revoke your consent at any
time by providing VCCF with written notice of your intent to revoke this consent.
VCCF will maintain this document or a true and correct copy thereof. You are entitled to a copy of this
document upon request and may want to keep a copy of this document for your records.
*PLEASE NOTE: If you do not sign this consent form, your application WILL NOT be
considered. You will NOT be eligible for ANY VCCF Scholarships.
DATE:
Applicant (Print Name)
Applicant Signature
DATE:
Parent/Legal Guardian (Print Name)
Parent/Legal Guardian Signature
DATE:
Parent/Legal Guardian (Print Name)
Parent/Legal Guardian Signature
*NOTE: Your parents need not sign this form if you are an independent student age 24 or older. You may claim
independent status only if you have (1) served in the military, (2) are a ward of the courts, (3) are married and
living away from your parents, or (4) you have not been claimed by your parents for two consecutive years
and have earned at least $4,000 in each of those two years.
VENTURA COUNTY COMMUNITY FOUNDATION
FINANCIAL AID ASSISTANCE QUESTIONNAIRE – Page 5
Applicant Name
YOU NEED TO SUBMIT THIS FORM IF YOU ARE APPLYING FOR ANY OF THE FOLLOWING SCHOLARSHIPS:
Delta Kappa Gamma Recruitment Grant
 Amy McAvoy Soroptimists Int’l of Camarillo
 Ventura County Agricultural
Michael A. DiRaimondo Foundation
 Orfalea Nursing Awards
 V.C. Medical Education Forgivable Loan
Finch Family
 Sage Scholarship*
 Vocational - Career & Technical Education
General Study Scholarship Pool
 Saticoy Lemon Association Employee
 Katherine M. Wakelee
Parker M. & Virginia Y. Howell
 Charles J. & Kay Schuler
 Kent Weigel Math Scholarship
Armando and Lourdes Lopez
 R.L. Sepulveda & R. Garcia/Latino Town Hall
 Iris and Roger (Spike) Wilkins
MacKenzie Family
 Salik Omar Shah
 Edna Wirt Woods and Ruth Nagel
 Eleanor Tillquist Scholarship
 Helen Mathilda Yunker Music
*NOTE: If you are applying for a Sage Scholarship, both parents must submit a copy of their federal income tax return even if they are
not living in the same household. For confidentiality, please black out your parents’ Social Security Numbers on their 1040 Forms.
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INCOME, EXPENSES, AND ASSET DATA
If you are a dependent student, please have your parents complete this form using information from their most recent IRS Tax
Return. (You are a dependent student if you are under 24 years of age.) If you are independent, information about you and your
spouse (if applicable), not your parents, must be included. Figures should be taken from your most recent U.S. Income Tax Return.
You are an independent student if you are 24 years of age or older. If you are under 24, you may claim independent status only if
you (1) served in the military, (2) are a ward of the courts, (3) are married and living away from your parents, or
(4) have not been claimed by your parents for two consecutive years and have earned at least $4,000 in each of those years.
I am a Dependent / Independent student (circle). If Independent, give reason #
Parent’s (or student’s as applicable) current marital status (circle):
single
. Documentation may be requested.
married
separated
divorced
Student
Parent
1.
Adjusted gross income (YEAR __________)
$
$
2.
Untaxed income and benefits (child support, AFDC, SSI, etc.)
$
$
3.
Savings and investments (NOT property, i.e., your home or IRA
or other retirement accounts)
$
$
4.
Major medical expenses not covered by insurance
List:
$
$
5.
Total number of family members
#
#
6.
Total number of family members who will be attending college
at least half time during the 2006-2007 academic year
widowed
#
CERTIFICATION
I certify that all the information on this form is true and complete to the best of my (our) knowledge. If asked by any authorized official of VCCF, I
(we) agree to give documentation for information given on this form. I (we) realize that this proof may include a copy of a U.S. tax return and/or
state income tax return. I (we) realize that failure to comply with a request for further information may prevent the applicant from receiving the
scholarship.
Applicant signature
Date
Parent (or spouse if applicable) signature
Date