SECTION I: STUDENT CONTACT INFORMATION

First Name *

Last Name *

Address

Street Address *

City *

State *

Postal Code *

Phone *

Email *

Birth Origin

SECTION II: PARENT CONTACT INFORMATION

(Mr., Mrs., Ms.) Last Name of Parent *

First Name of Parent *

Address if different than the student:

Street Address of Parent

City of Parent

State Address of Parent

Postal Code of Parent

SECTION III: STUDENT INFORMATION

High School Currently Attending *

Grade Level *

School Phone

School Street Address *

School City *

School State *

School State

School Postal ID *

SECTION IV: SCORES

Download the Form Here. (This from is to be completed by school’s guidance staff)

Upload the Completed Form Here: *

Upload the Completed Form Here:

SECTION V: LEADERSHIP ROLES / ACCOMPLISHMENTS

Please list below all leadership roles you have held, organizations in which you are involved including the dates of participation and any special awards, achievements, or accomplishments in academics, arts, ROTC, and sports that you have been honored with. You may include this information as part of your résumé.

Leadership Roles / Accomplishments *

SECTION VI: COLLEGE AND CAREER PLANS

a. Which college(s) do you plan to attend? *

b. In which field(s) do you plan to major? *

c. Which career field do you plan to enter? *

SECTION VII: ESSAY

The essay should have a maximum of 500 words, and must be typed and double-spaced, two pages maximum.

a. Respond to the following topic in an essay.

“How has being an Asian American or Asian American culture helped you to be who you are today and helped to influence your future plans?”

b. Please include any hardships, challenges that you have experienced and explain your actions to overcome them.

Upload your Essay File *

Upload your Essay File

SECTION VIII: LETTER OF RECOMMENDATION

Please provide one letter of recommendation from a teacher, church leader, coach, or other person of your choosing to recommend you for this scholarship. This letter must be typed on official letterhead and is limited to one page only with font size no smaller than 12.

Upload the Letter of Recommendation *

Upload the Letter of Recommendation