2015-2016

The Mildred E. Hight Teaching Scholarship

Deadline Friday, February 20, 2015 at 12:00pm.

Scholarship Application Instructions Complete the Mildred E. Hight Teaching Scholarship Application typed or neatly printed in blue or

black ink. Your Application for Admission must be in the college’s admission database for you to be

considered for a scholarship. If you are not currently enrolled at MSJC, complete a MSJC Application for Admission Online form at www.msjc.edu/ and click on “apply for admission.”

Be enrolled for minimum unit requirements for the Fall semester 2015 and Spring semester 2016.

Minimum 3.00 GPA or Higher Male or Female Teaching Major Minimum of 9 units each semester Financial Need

Complete Financial Statement. Financial need is required for some scholarships and the financial

statement must be completed and submitted with your application form. Attach two (2) current Applicant Evaluation Forms or recommendation letters. Request two

individuals, such as teachers, employers, or community leaders who are familiar with your career goals.

Respond to the following essay questions. Do not submit any other document or statement.

Major/Goals. Describe why you selected your major area of study and your future academic and career goals.

Adversity/Challenges. Describe any adversity or challenges you have

overcome or anticipate in pursuit of your educational goals.

Sign and date the “Student Certification”. Your scholarship application will not be valid unless signed. Attach copies of your unofficial transcripts from all schools that you attended.

Submit your scholarship application and all required documentation to the Foundation Office

drop box located in the Student Service Building Lobby. San Jacinto Campus Building 1150 or Menifee Campus Building 100. You can also mail your scholarship application to: MSJC Foundation Office 1499 N. State Street San Jacinto, Ca. 92583 by the deadline of Friday, February 20, 2015 at 12:00pm.

Decisions of the scholarship committees are final. Eligibility does not guarantee a scholarship.

PERSONAL INFORMATION

MSJC I.D. # ________________________________

Name_____________________________________________________________________________________ Last First Middle

Current Mailing Address_____________________________________________________________________ Street Number City State Zip

Phone Number (_____) ____________________ Date of Birth________________________________

Last High School Attended_____________________________________________ __________________________

Name of High School State Graduation Date

Colleges attended other than Mt. San Jacinto College

Name of College Cumulative GPA Units Earned Dates Attended

Are your registration fees & books currently being paid by a program or someone other than yourself?

Yes_______ No____ Program _____________________________ Amount $ ________________

Are you a single parent with dependent children living with you? Yes________ No________

Are you a re-entry student (out of school at least one year)? Yes________ No________

FINANCIAL STATEMENT

Financial need is a criterion for the MSJC Community Foundation Scholarship. This form must be completed for you to be considered for financial need based scholarships. It is essential that this form reflect a true picture of your household finances. Report all income in yearly

figures (monthly x 12) for the calendar year 2014.

Income information for 2014 APPLICANT’S HOUSEHOLD SIZE (Please do not include roommates) ANNUAL HOUSEHOLD INCOME Note: indicate income received for the calendar year 2014 only APPLICANT’S/SPOUSE’S INCOME (if applicant currently married) Income/wages $ (student) $ (spouse) Child support received $ (student) $ (spouse) Alimony received $ (student) $ (spouse) Social Security $ (student) $ (spouse) Military housing (benefit amount) $ (student) $ (spouse) Other income $ (student) $ (spouse) PARENTS’ INCOME (if applicant under 24 and unmarried) This information must be included even if you do not live with your parents Income/wages $ Child support received $ Alimony received $ Social Security $ Military housing (benefit amount) $ Other income $

TOTAL HOUSEHOLD INCOME FOR 2014 $______________

COLLEGE EDUCATIONAL GOAL MSJC Educational Goal: A.A. or A.S. Degree_____ Certificate_______ Transfer_______

MAJOR ___ADMIN OF JUSTICE ___ENGINEERING ___PHILOSOPHY

___ANTHROPOLOGY ___ENGLISH ___PHOTOGRAPHY

___ART ___ENVIRONMENTAL SCIENCE ___PHYSICAL ED.

___ASTRONOMY ___GEOGRAPHY ___PHYSICS

___AUTO TECHNOLOGY ___HEALTH SCIENCE ___POLITICAL SCIENCE

___BIOLOGY ___HISTORY ___PSYCHOLOGY

___BUSINESS ___MATHEMATICS ___SOCIOLOGY

___CHEMISTRY ___MUSIC ___TEACHING

___COMPUTER SCIENCE ___NUTRITION ___THEATRE ARTS

___ECONOMICS ___NURSING ___OTHER (SPECIFY)

___________________

Career Goal: Expected Date of Graduation from Mt. San Jacinto College _________

Month Year

Do you plan to be a teacher when you complete your education? Yes _____ No_____

Do you already have an Associate’s Degree (A.S. or A.A.)? Yes _____ No_____

Are you transferring as a junior in the Fall 2015? Yes_____ No_____

If yes, have you applied for Admission? Yes_____ No_____

f yes, have you been accepted? Yes_____ No_____

Name of the college you plan to attend in the Fall 2015 if not MSJC____________________

COMMUNITY INVOLVEMENT

List on/off campus club or organizational activities to which you volunteered your assistance in the past two years.

NOTE: Do not include organizations where you are employed, received compensation, or earned college credits.

1. Name of Organization

Contact Person Title Phone

How many volunteer hours a week do (or did) you provide?

Volunteer Period Beginning Date Ending Date ______

2. Name of Organization

Contact Person Title Phone _

How many volunteer hours a week do (or did) you provide?

Volunteer Period Beginning Date Ending Date ______

3. Name of Organization

Contact Person Title Phone _

How many volunteer hours a week do (or did) you provide?

Volunteer Period Beginning Date Ending Date ______ Student Offices Held ____________________________________________________________________

Awards and Recognitions _________________________________________________________________

ESSAY ADVERSITY AND CHALLENGES

Responses must be typed. (Attach to your completed scholarship form)

Describe any adversity or challenges you may overcome or anticipate in pursuit of your educational goals.

ESSAY MAJOR AND GOALS

Responses must be typed. (Attach to your completed scholarship form)

Describe why you selected your major area of study and your future academic and career goals.

The Mildred E. Hight Teaching Scholarship Applicant Evaluation Form To The Evaluator: Scholarship applicants must submit an Evaluation Form when applying for scholarships from at least two qualified individuals. The Evaluation form must include your name, title and contact information. The Evaluation Forms must be submitted by the applicant at the same time as they submit their scholarship application. Please return the Evaluation to the student in plenty of time for them to meet the deadline. You may also write a recommendation in letter format if you choose.

__________________________________________________________ _____________________________ Name of Applicant Student ID#

1. How long have you know the student and in what capacity?

2. Please rate the applicant on the following in comparison with other students of the same level: Exceptional Above

Average Average Below

Average No Information

General Academic Ability

Motivation and Initiative

Quality of Work

Willingness to Learn

Imagination and Creativity

Dependability/Responsibility

Social Skills/Leadership Ability

Potential to Succeed

3. Please provide any additional comments about the applicant below. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

X_______________________________ ___________________ Evaluator’s Signature Date _______________________________ Print Name and Title

The Mildred E. Hight Teaching Scholarship Applicant Evaluation Form To The Evaluator: Scholarship applicants must submit an Evaluation Form when applying for scholarships from at least two qualified individuals. The Evaluation form must include your name, title and contact information. The Evaluation Forms must be submitted by the applicant at the same time as they submit their scholarship application. Please return the Evaluation to the student in plenty of time for them to meet the deadline. You may also write a recommendation in letter format if you choose.

__________________________________________________________ _____________________________ Name of Applicant Student ID#

1. How long have you know the student and in what capacity?

2. Please rate the applicant on the following in comparison with other students of the same level: Exceptional Above

Average Average Below

Average No Information

General Academic Ability

Motivation and Initiative

Quality of Work

Willingness to Learn

Imagination and Creativity

Dependability/Responsibility

Social Skills/Leadership Ability

Potential to Succeed

3. Please provide any additional comments about the applicant below. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

X_______________________________ ___________________ Evaluator’s Signature Date _______________________________ Print Name and Title

List any scholarship(s) that were awarded to you for the Fall 2014 – Spring 2015 academic year.

1. _________________________________________________________________ 2. _________________________________________________________________ 3. _________________________________________________________________ 4. _________________________________________________________________ 5. _________________________________________________________________ 6. _________________________________________________________________

Please do not write below this line.

____________________________________________________________ For Office Use Only

MSJC Units Completed______ Other Institutional Units______

Total Units Completed______ Spring 2015 Units________

Cost of Attendance 2015/2016 $_________________

Awarded Financial Aid for 2015/2016 $_________________

Eligible for Financial Aid ______Yes ______No If no, reason why_________________________________

_______________________________________________________________________________________

Unmet Need: $__________

STUDENT CERTIFICATION Financial need may be considered in determining eligibility. It must be emphasized that eligibility for scholarships is mainly based on your ability to meet scholastic and other criteria as set forth by the scholarship donors. The information you supply on your scholarship application is recognized by the college to be confidential and you agree that the college may reveal or forward the contents of your application to the MSJC Foundation committee members and/or other reviewing committees. Any disclosure of confidential information associated with any application to individuals not directly associated with the evaluation process is prohibited. Signature is required for your application to be considered.

I, certify that all information given in this application and

other documents is true and complete to the best of my knowledge. If asked by an authorized

official of MSJC, I agree to give proof of income, which may include a copy of my (and spouse’s)

and/or parent’s 2014 U.S. Income Tax Transcript. I also realize that any false statement or failure to

give proof of income when asked may cause the denial of my scholarship application. I understand

that the information requested on this application is confidential. I authorize Mt. San Jacinto College

to release enrollment and financial data to scholarship donor(s). MSJC may use the

information I have provided for publicity purposes.

_________________________________________________________________

Print Name

_______________________________________________ __________________

Applicant’s Signature Date