*You must submit a new application for each semester (fall or spring) in order to be considered for scholarships for that semester.

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Board of Directors President

Susan Ovitt

Chaffey Joint Union High School District

Immediate Past President

James Touchstone Jones & Mayer

Vice President Loren Sanchez Secretary Ken Galasso Sierra Realty Treasurer Vacant Mark Barragan Estrada Strategies Jeanne Batista JMBatistaSolutions Members Virginia Aguilar-Riley Guillermo Canjura Guillermo Canjura, DDS Mary Caporale Edward Jones Glenn Duncan City of Chino Richard Egger Best Best & Krieger, LLP Aref Fakhoury ARMGHRD Group, Inc. Otis Greer

County of San Bernardino Sue Oxarart

Ontario Convention & Visitors Bureau Sandra Rose Henry Shannon Chaffey College Chris Taylor HMC Architects

Chaffey College Support Staff

Lisa C. Nashua, MSLM Executive Director, Foundation and Governmental Relations Marie Baston

Foundation Coordinator Lissa Napoli

Administrative Assistant II Sharon Awad

Scholarship Program Assistant

Dear Chaffey College Student:

Thank you for your interest in applying for a Chaffey College Foundation Scholarship.

We are proud to provide scholarships to qualifying and deserving students. Through

the generosity of local businesses, professional associations, and individuals, the

Chaffey College Foundation is able to offer scholarships to students pursuing their

educational goals.

Please read the following valuable information to make sure you are fully aware of the

requirements for these scholarship opportunities. It is important that you follow all

directions and fully complete the application packet.

You must be a registered and current Chaffey College student. All Chaffey College

Foundation Scholarships will be awarded in the

2015-2016

Academic Year.

Recipients receive a scholarship account card that can be used to purchase books and

supplies at the college bookstore, or at the Cashier’s Office to pay for any fees or

charges related to enrollment. Any scholarship recipient that is dismissed from, or

drops out of Chaffey College will forfeit their scholarship.

Applications will be accepted during the fall and spring semesters of each academic

year. The Chaffey College Foundation Scholarship Committee reviews applications

twice a year for awarding. Scholarship applications for the

spring semester

scholarship round of the 2015-2016 academic year will only be accepted between

November 1, 2015-January 20, 2016.

Applications are being accepted in the

Foundation Office (MOD-1 Rancho Campus), the Fontana Campus Bookstore

(FNAC-129), and the Chino Campus Bookstore (CHMB-149).

*

You must submit a new application for each semester (fall or spring) in order to

be considered for scholarships for that semester.

Your application will be evaluated according to the following general eligibility

criteria:

1.

Demonstrated Financial Need

2.

Minimum Cumulative GPA of 2.5 and/or Evidence of Significant Improvement

in Academic Performance.

3.

Personal Statements

4.

Educational Goals

5.

Community and/or College Involvement

6.

Transcripts: IF this is your first semester here at Chaffey College you will need

to submit an unofficial transcript from the previous school you attended. You

can visit your former school to obtain your transcripts or go to

www.parchment.com, to set up an account and receive your transcripts in the

mail. Fees may apply.

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Please include as much information as you feel comfortable sharing. Remember that this is your ONLY

opportunity to share with the scholarship committee WHY you need this scholarship and since they will not

have the opportunity to meet with you at this time make sure to tell them about yourself in the essay portion of

this application. Please feel free to add additional word documents if necessary.

Sincerely yours,

Lisa C. Nashua, M.S.L.M.

Executive Director

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Online application available at:

www.chaffey.edu/scholarships

For Office Use Only

Date & Time Received

 

Chaffey  College  Foundation  Scholarship  Application  

This  scholarship  is  open  to  all  Chaffey  College  students  regardless  of  citizenship  or  residency  status.  

Student  ID  Number:               Gender:    Male             Female              

New  Student          Continuing  Student       Have  you  received  a  Foundation  Scholarship  in  the  past?         Full  Legal  Name:  First                    Middle  Initial  _____      Last               Date  of  Birth  (mm/dd/yy):  _____    _____    _____   Did  either  of  your  parents  ever  attend  college?      Yes     No      

Did  either  of  your  parents  or  any  other  member  of  your  immediate  family  ever  attend  Chaffey  College?    Yes     No      

E-­‐mail  address:            

(E-­‐mail  confirmations  will  be  sent  out  regarding  this  scholarship  application  as  well  as  information  of  other  available   scholarships.)  

 

 

Permanent  Address:  

Number  &  Street  _______________________________________________________________      Apt.  #          

  City  ___________________________      State  _____      Zip  Code  __________      Mobile  Phone  (_____)  ______-­‐___________    

   

  Home  Phone  Number  (_____)  _____-­‐_____________    Alternative  Phone  Number  (_____)  ______-­‐___________      

 

Total  units  earned  to  date:  __________      Transferable  units  earned:  __________      Cumulative  GPA:         Current  enrollment  status:  Part-­‐time  _____Full-­‐time_____  Less  Than  Half  _____Transferring:  Fall  _____  Spring  _____  Summer_____            (Minimum  6  units)      (Minimum  12  units)  

 

Declared  or  Expected  Major:                          

     (According  to  your  education  plan)  

*Have  you  taken  any  the  following  courses  as  of  today?      

1. CISPROG  1:  Intro  to  Computer  Programming      Yes______  No______       2. CISPROG  3:  Fundamentals  of  Visual  Basic  Programming      Yes______  No______  

3. CISPROG  403:  Advanced  Basic  Programming            Yes______  No______   4. CIS  431:  Project  Management  for  Information  Technology      Yes______  No______    

*If  you  are  a  nursing  major,  are  you  in  the  actual  nursing  program  as  of  today?  Yes______  No______    

   

Work  experience  (list  last  four  jobs  only)  

ACADEMIC  INFORMATION  

WORK  EXPERIENCE/  EXTRA  CURRICULAR  ACTIVITIES  

PERSONAL  INFORMATION  

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Online application available at:

www.chaffey.edu/scholarships

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Are  you,  or  have  you  ever  been  a  foster  youth?               Yes_____   No  _____   If  yes,  are  you  able  to  provide  legal  documentation  confirming  this  information?       Yes_____   No  _____   Have  you  completed  the  “Free  Application  for  Federal  Student  Aid”  (FAFSA)  form?           Yes_____   No  _____     If  yes,  what  is  the  status:  _________________________________________________________  

Have  you  ever  received  a  scholarship  as  a  Chaffey  College  student?      Yes  _____   No  _____   If  yes,  please  list  which  scholarship(s):  _______________________________________________  

Are  you  a  veteran  of  the  U.S.  armed  services?             Yes_____   No  _____   If  yes,  are  you  receiving  GI  benefits?               Yes  ____  _   No  _____   Are  you  a  registered  DPS  Student?                 Yes_____      No  _____  

Are  you  a  CARE  Student?                   Yes_____   No_____  

Are  you  an  EOPS  student?                   Yes_____   No_____  

Are  you  part  of  the  CalWORKs  program  offered  through  Chaffey  College?       Yes_____   No_____    

 

For  SECTIONS  1  AND  2:  Do  NOT  fill  out  both  sections,  choose  one  or  the  other  

SECTION  1.   INDEPENDENT  APPLICANT:  (This  section  applies  to  you  if  you  were  born  before  January  1,  1990)  

Are  you  currently  receiving  Government  Assistance?  If  Yes,  (check  all  that  apply  below)         Yes       No                CalWORKs  ,    CalFresh,    or    Medical  

Are  you  receiving  SSI  (Supplemental  Security  Income)?           Yes       No             Are  you  receiving  GA  (General  Assistance)?                 Yes       No             Economic  Status:  is  your  household  annual  income  less  than  $12,525  (for  a  single  person);  $16,875  (for  a  couple  adding  $4,350.00   per  dependant  child)?                     Yes       No             Are  you  a  Displaced  Homemaker?An  individual  who  has  worked  primarily  without  receiving  compensation  to  care  for  a  home  and   family,  and  for  that  reason  has  diminished  marketable  skills.           Yes       No             Please  estimate  your  TOTAL  annual  gross  household  income:  $            

 

SECTION  2.   DEPENDENT  APPLICANT:  (This  section  applies  to  you  if  you  are  under  24  years  of  age  unless  you  are  a  Graduate  Student,   are  married  or  have  dependents  other  than  a  spouse,  are  an  orphan/ward  of  the  court,  or  are  a  veteran  of  the  U.S.  armed  services)  

Parent(s)’/Guardian(s)’  Marital  Status:    Single     Married          Separated        Divorced        Widowed           Mother’s/Guardian’s  occupation:  _______________________        Father’s/Guardian’s  occupation:  ______________________   Parents/Guardians  TOTAL  combined  annual  gross  household  income:  $__________________________        

Do  your  parent(s)/guardian(s)  contribute  to  your  educational  expenses?  Yes     No  ___   Do  you  live  with  your  parent(s)/guardian(s)  during  the  academic  year?    Yes      No___    

Number  of  people  your  parent(s)/guardian(s)  can  claim  as  dependents  on  their  tax  return  (include  yourself):         How  many  dependents  are  currently  in  college  (include  yourself)?  _____    

Are  either  parent/guardian  a  Veteran?    __________  

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Online application available at:

www.chaffey.edu/scholarships

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Certification  and  Authorization:    Applicant  must  read  and  sign  below  to  be  eligible.      

“All   of   the   information   on   this   application   is   true   and   complete   to   the   best   of   my   knowledge.     I   certify   that   I   meet   all   eligibility   requirements   as   specified   in   this   application.     I   understand   that   I   may   or   may   not   receive   a   scholarship   and   that   filling   out   this   application  does  not  guarantee  that  I  will  be  selected  as  a  recipient  of  a  Chaffey  College  Foundation  scholarship.    I  understand  that   all   application   materials   become   the   property   of   the   Chaffey   College   Foundation,   cannot   be   returned,   and   will   be   treated   as   confidential.    Any  knowingly  false  statements  on  this  application  may  disqualify  me  from  consideration  for  a  scholarship.    I  hereby   authorize  the  Chaffey  College  Foundation  to  utilize  information  about  my  application,  thank  you  letter,  and  my  likeness  for  public   relations  purposes,  publicity,  or  other  scholarship  opportunities.”  

 

Signature  _________________________________________________   _      

 

Date  __________________  

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