Siverts Publishing Scholarship

2015 Scholarship Application

Application Deadline:  Received by April 1, 2015 

Please print or type

1. APPLICANT INFORMATION:

Name:__________________________________________________________________

Address:  _______________________________________________________________

City:  ____________________, California       Zip Code:  _________________________

Home Phone (     ) _________________   E-Mail Address:  _______________________

Date of Birth:  ____________________    Male   ______    Female   _______

1. FAMILY INFORMATION:

Parent or Guardian Name:  _________________________________________________

Address:  _______________________________________________________________

Occupation:  ________________________ Work Phone (     ) ____________________

III. TRANSCRIPT INFORMATION:  A school verified transcript must be attached to this application

GPA:  ______      SAT Scores:  Critical Reading ______ Math ______ Writing ______

1. MAJOR SCHOOL ACTIVITIES: List all school activities in which you have participated during the past 4 years (i.e., student government, legitimate school clubs or campus organizations, Performing Arts, sports, etc.)

1. COMMUNITY SERVICE: List all community activities in which you have participated in without pay during the past 4 years (i.e., scouts, church involvement, volunteer work, etc.)

1. WORK EXPERIENCE:

VII. COLLEGE/UNIVERSITY APPLIED TO AND MAJOR:  The accredited colleges/universities I have applied to for the 2014 Fall Term are:

1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________

VIII.  ESSAY:  Please write an essay (maximum of 3 pages double spaced) telling us about yourself, your family, hobbies, extracurricular activities, interests and/or travels, educational goals, community service and business internships you have done and why you should be chosen for this scholarship.

IX:  LETTERS OF RECOMMENDATION:  Please attach two (2) letters of recommendation. One must be from a teacher. The second letter can be an individual in your community, your church, your work, or personal reference who is knowledgeable about your academic capabilities, skills, talents, and accomplishments.

X:  PROJECT SUBMISSION: Applicants are required to submit a sample of work done in their intended course of study (ie. Graphic design artwork, news articles written, photographs, radio or TV scripts or recordings, videos, or other creative work). Video or audio recordings cannot exceed 5 minute.

1. APPLICANT CERTIFICATION:

I certify that the information provided in this application is complete and accurate to the best of my knowledge.  I understand that falsification of information may result in termination of any scholarship granted.

Printed Name:  ___________________________________________________________

Signature:  __________________________________ Date:  ______________________