(2013-2014)
WEST VALLEY/MISSION COLLEGE
SCHOLARSHIP APPLICATION
(For Current West
Valley/Mission College Students)
Please Print
(BLACK INK) or Type-This document will be photocopied
GENERAL
INFORMATION
Name:____________________________________________
SS#____________________
Last
First
Middle
Address:
_______________________________________ Date of Birth: ________
City/Zip:
________________________ Phone #: ___________________
Email address:
__________________________________________________
Name of Tribe, Band,
or Group _________________________________
__
Federally recognized
(include Alaska Native)
__
State recognized
__
Terminated
Marital Status: __
Other Organized Group
___ Single ___ Married Membership in name of
_____________________
___ Head of
Household __Other
___ Household size
EDUCATIONAL
BACKGROUND
Name of high school
attended: _______________________
Graduated: __ Yes Graduation date:
______________ G.P.A.
_____
__
No GED? __Yes __ No
List the course
title and units of current enrollment at the college
Course
Title Units
______________________________________ ______
______________________________________ ______
______________________________________ ______
______________________________________ ______
Total number of
units completed at West Valley/Mission College(circle):
______ units ______G.P.A.
Other colleges:_________________________________________________
______ units ______G.P.A.
Note: GPA must be
a minimum of 2.5
__________________________________________________________________
College Major:
_____________________
Degree:
__Certificate __
DEADLINE: Friday, Sept. 27