LOS MEDANOS COLLEGE FOUNDATION
2013-2014 SCHOLARSHIP APPLICATION
The LMC Foundation Scholarship Program offers a variety of
scholarships through one convenient application.
TO BE CONSIDERED FOR AN LMC FOUNDATION SCHOLARSHIP YOU MUST:
 Be a Los Medanos College student
 Have a minimum GPA of 2.0 (GPA varies depending on the scholarship)
 Submit an essay, two letters of recommendation and a copy of your unofficial transcript
(see instructions below for more information)
 Meet all of the eligibility requirements for scholarship(s)
REQUIRED DOCUMENTS:
1. A completed 2013-2014 LMC Foundation Scholarship Application.
2. Two letters of recommendation total: one letter must be from an LMC Staff member.
3. A typed, 500 word essay (personal statement) stating your financial situation, educational and career
goals, community service, school activities, work experience, and other specific questions asked to
emphasize in your essay (one essay can suffice for multiple scholarships).
4. An unofficial LMC transcript (may be obtained from Web Advisor/ Insite at www.losmedanos.edu).
INSTRUCTIONS:
AFTER CAREFULLY READING THROUGH EACH SCHOLARSHIP & ELIGIBILITY REQUIREMENTS,
CHECK THE SCHOLARSHIP(S) BELOW FOR WHICH YOU WISH TO BE CONSIDERED.
VERY IMPORTANT: TYPE, PRINT AND SIGN YOUR COMPLETED APPLICATION AND RETURN IT
TO THE SCHOLARSHIP OFFICE, PS2-23 WITH SUPPORTING DOCUMENTS (ESSAY, LETTERS OF
RECOMMENDATION AND TRANSCRIPT) BY THE DEADLINE. DECISIONS ARE MAILED TO
STUDENTS IN APRIL 2013.
FOR QUESTIONS PLEASE CONTACT THE SCHOLARSHIP OFFICE AT (925) 439-2181, EXT. 3130.
GOOD LUCK!
DEADLINE FOR SUBMISSION IS FEBRUARY 19, 2013
Los Medanos College Foundation Scholarship Application
This page must be attached to your completed application packet
African-American Staff Scholarship-Continuing Student
Industrial Assoc. of CCC Scholarship
African-American Staff Scholarship-Transfer Student
Inter Club Council (ICC) Scholarship
Alma Flores Lutz Memorial Scholarship
Jeffrey Lieske Math Scholarship
American Assoc. of University Women-Concord Branch
Josie Gardunio Memorial Scholarship
American Assoc. of University Women-CC-Delta Branch
La Raza Faculty and Staff Scholarship-Cont.
Antioch Rotary Club Scholarship
La Raza Faculty and Staff Scholarship-Trans.
Brentwood Rotary Club Scholarship
Leung Family Memorial Scholarship
Carla Zilbersmith Memorial Scholarship
LMC Carol & John Slatten Nursing Scholarship
CCCSAA (California Community College Student Affairs
LMC Staff Scholarship-Cont. Student
Association) Student Leadership Scholarship
LMC Staff Scholarship-Transf. Student
LMCAS (Assoc. Students) HOSTS Scholarship
Classified Senate Student Scholarship-Cont. Student
LMCAS (Assoc. Students) Scholarship
Classified Senate Student Scholarship-Transf. Student
Matthew Shepard Tolerance Scholarship
Columbia Hernandez-Fernandez Memorial Scholarship
Ofelia Marino Memorial Scholarship
Danielle Lieske Science Scholarship
Perry-Folino-Dramatic Writing Scholarship
Delta Rotary Club Scholarship
Pittsburg Latin-American Club Scholarship
Doyle Hawkins Memorial-Cont. Student
Pittsburg Rotary Club Scholarship
Doyle Hawkins Memorial-Transf. Student
Powers Family Scholarship
Ellen Swallow Richards Scholarship
S.L. Meigs Memorial Scholarship
Enes Bramhall Memorial Scholarship
Soroptimist Intl’ of Antioch Scholarship
Gene Thomas Memorial Scholarship
Soroptimist Intl’ of Pittsburg Scholarship
George J. and Dera M. Lewis Scholarship
Stanley H. Chin Memorial Scholarship
Gloria Garlitos Memorial Scholarship
Vince and Mary Custodio Scholarship
Student Name:
Student ID:
Los Medanos College Foundation Scholarship Application
CONTACT INFORMATION
Student's Name
Permanent Home Address
Phone #
E-Mail Address
Student ID#
Gender:
U.S. Citizen?
I am an:
Yes
Out-of-state student
Single (never married)
Married
In-state student
Divorced
Are you currently registered in LMC’s Disabled Students Program? Yes
LMC Class Standing
Female
No
International student
Marital Status:
Male
AB540 student
Separated
No
Freshman
Sophomore What is your G.P.A.?
How many units currently enrolled in?
How many LMC units completed
Will you be continuing at LMC during the Fall 2013 and Spring 2014 academic year? Yes
No
Will you be transferring from LMC to a four-year college/university in the Fall 2013 semester? Yes
Spring 2014 semester? Yes
No
If so, list campus of transfer
LMC college major
Degree Pursuing (at LMC):
No
or,
Career Choice
Associate
Certificate of Achievement
None
Expected Graduation Date:
SUPPLEMENTAL INFORMATION
1. Do you reside with your parents?
Yes
No
Spouse? Yes
No
2. How many persons will be living in your household during 2013-2014?
3. Of the number of persons in question #2, how many will be in college full time during the 2013-2014 academic
year?
Los Medanos College Foundation Scholarship Application
4. During the 2013-2014 academic year, will you be a single parent with dependent children living with you?
Yes
No . (If yes, how many?)
5. How many hours per week do you work?
6. What was your adjusted gross income for 2012 (if unknown at this time, use 2011 information)?
7. What was your parent's or spouse’s adjusted gross income for 2012 (if unknown at this time, use 2011
information)?
8. Have you applied for Financial Aid (submitted a FAFSA form)?
Yes
No
9. Any extenuating financial needs or reason for lack of community services you would like to be considered?
AWARDS AND ACTIVITIES: List in reverse chronological order (most recent to least recent) college clubs and
organizations with which you have been involved. Include honors, offices held, responsibilities taken on, etc.
I certify that I have read all the information and instructions regarding this application. I also agree to all stipulations
written herein. I certify that the information provided in this application is, to the best of my knowledge, true and
correct. I understand that all information is subject to verification and that falsification of information may result in
termination of any scholarship granted. I give permission for the release of application materials (including application
forms, transcripts, personal statement, and letters of recommendation) to authorized Los Medanos College
scholarship committees and/or Los Medanos College Foundation donors.
Student Signature
Date
Guardian Signature (only if student is a minor under the age of 18)
Date
Los Medanos College Foundation Scholarship Application