RASSAVONG SCHOLARSHIP FOUNDATION
California Non-Profit Public Benefit Corporation #2710049

Rassavong Foundation Scholarship
Scholarship Application Form

APPLICANTS PLEASE PRINT AND COMPLETE THIS FORM

Scholarship Award

The Rassavong Foundation Scholarship will grant individual scholarship awards in the amount of $1,000 each per person per year. The first available scholarship award will be fall 2008.

Eligibility Criteria

(a) Scholarships are awarded on the basis of merit among all eligible applicants. Personal achievement, tenacity in the face of adversity, ambition, skill, charity, breadth and strength of character are example factors taken into consideration.

(b) Federal 501(c)(3) regulations require scholarship programs benefit members of a charitable class, e.g., a group large enough that in indefinite number of individuals may benefit, or a group that is by virtue of circumstances beyond the control of the Award Committee. All scholarships are awarded in a fair, equitable and non-discriminatory selection process and are subject to the approval of the Foundation Directors.

Student enrolled or accepted with active status at an accredited secondary education organization such as a college, university, institute or trade school.
Maintain a local California San Diego County residence.
If living with family, spouse or domestic partner, a household income of under $100,000 annually; or if living independently, an income of under $50,000 annually.
Established record of accomplishment, achievement, skill or charity.
Minimum academic GPA of 3.5 on a 4.0 scale.

Application Deadline

Applications must be postmarked no later than June 30, 2008 for the fall season awards.

Panel Interview

Finalist applicants will be interviewed in person by a panel consisting of an independent scholarship awards committee. The committee will contact the applicant to set a mutually agreed interview appointment time between July 1 and July 31, 2008.

Privacy Policy

The Foundation's policy expressly prohibits its officers, directors, award committee members and/or other designated agents from sharing, copying or distributing scholarship applications and materials or information from our contributing benefactors, for any purpose outside of the execution of their duties for the Foundation.

Application Form

Please complete your application blue or black ink.

1. Applicant Information

Name; Last, First, Middle Initial(s):
Mailing Address:
Residential Address, if different from postal mailing address:
Phone number:
Email (optional; used only for scholarship-related correspondence):

Name of accredited Institution, College, University, or Trade School, etc. you are attending:
Enrollment/Acceptance Date:
Fall Class Session/Semester Date:
Academic GPA (4.0 scale): NOTE: Excludes P.E., sports, music, arts, etc.
Overall GPA (4.0 scale):

Select ONE income qualification type:	⁭ Family income qualification (below $100,000 annually) ⁭ Personal income qualification (below $50,000 annually)

2. Materials and References Checklist

Please attach the following with your application:

⁭ Evidence of limited income meeting the income requirements of Eligibility Criteria (c), above.

⁭ Evidence of accepted or active student status at an accredited secondary education college, university, institute or trade school (copy of student ID, acceptance letter, transcript, etc.)

⁭ Academic GPA - transcript (high school transcript for students entering college, university or trade school)

⁭ Evidence of your local California San Diego County residence (typically an original utility bill showing your family name)

⁭ Evidence of your established record of accomplishment, achievement, skill or charity.

⁭ At least three written recommendations, including reference contact information, from current or prior teachers, professors, mentors, clergy, community leaders, excluding family members (brothers, sisters, parents, grandparents, uncles, aunts, cousins, members of a shared household, etc.)

3. Questionnaire

Please attach your written responses to the questions below.

(a) What FIVE words do or would your references use to best characterize you, and why?

(b) In what specific ways have you contributed to your community or another community in the last 18 months?

(d) Which historical figure do you most admire, and what qualities did he or she express that you find them admirable? Why?

(e) What are your top three strengths, and what can be done to turn your worst three weaknesses into strengths?

(f) Describe how your greatest personal challenge or adversity forever changed you.

(g) What is your most significant achievement, and why does it stand above your other accomplishments and the accomplishments of most of your peers?

4. Written Essay

Write and attach a 1 or 2 page essay describing what roles of passion, perseverance, dedication and effort play in personal achievement, and what you have learned about yourself from experiencing or exhibiting these traits.

5. Student Applicant Affidavit and Signature

The foregoing information, questionnaire responses and submitted materials evidence are solely my own and of my own original accord. I understand that falsification of records or materials, plagiarism, or receiving assistance completing the above questionnaire is grounds for immediate disqualification.

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Printed Full Name

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Signature Date

Rassavong Foundation Scholarship Scholarship Application Form