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Cambodian-American Scholarship Application

First Name:
Last Name:
Social Security Number:   
Home Telephone:    
Email:
Address:
City: State:   
Where do you rank in your class?  Out Of:
What is your overall GPA?   
What school will you attend next year?  
What is your intended field of study?  
 
Other scholarships, financial awards, or loans granted:
Name: Amount:
Name: Amount:
Name: Amount:
Name: Amount:
Name: Amount:
   
Work Experience:
Employer: Hrs/Wk:
Employer: Hrs/Wk:
Employer: Hrs/Wk:
Employer: Hrs/Wk:
Employer: Hrs/Wk:
   
Volunteer / Community Work
Activity: Frequency:
Activity: Frequency:
Activity: Frequency:
Activity: Frequency:
Activity: Frequency:
   
Extracurricular Activities (Clubs, Athletics, Affiliations)
Activity:
Role:
Activity:
Role:
Activity:
Role:
Activity:
Role:
Activity:
Role:
   
Essay
What challenges do Cambodian-American communities face and what would you do to help resolve them? (2-3 pages, single spaced, Arial font, size 11)
   
Family Information
Mother / Guardian Name: 
Address: 
Telephone: 
Address: 
Telephone: 
   
Dependents in the Household (Brothers / Sisters)
Name: Age:
School:
Name: Age:
School:
Name: Age:
School:
Name: Age:
School:
Name: Age:
School:
   

Application Checklist

  • Completed Application Form
  • Copy of completed current tax form 1040 of parent of guardian (or any State or Federal Financial Assistance Source) MUST ACCOMPANY APPLICATION
  • Copy of High School Transcript - MUST ACCOMPANY APPLICATION
  • Copy of post secondary school acceptance letter - MUST ACCOMPANY APPLICATION
  • Two (2) letters of reference from a Guidance Counselor, Teacher, Employer, and/or Non-Family Adult - MUST ACCOMPANY APPLICATION

NOTE: Failure to properly complete the application with all the attachments, or to meet the deadline date, will make you ineligible for an award.