*You must submit a new application for each semester (fall or spring) in order to be considered for scholarships for that semester.

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1 Board of Directors President Susan Ovitt Chaffey Joint Union High School District Immediate Past President James Touchstone Jones & Mayer Vice President Loren Sanchez Secretary Ken Galasso Sierra Realty Treasurer Vacant Mark Barragan Estrada Strategies Jeanne Batista JMBatistaSolutions Members Virginia Aguilar-Riley Guillermo Canjura Guillermo Canjura, DDS Mary Caporale Edward Jones Glenn Duncan City of Chino Richard Egger Best Best & Krieger, LLP Aref Fakhoury ARMGHRD Group, Inc. Otis Greer County of San Bernardino Sue Oxarart Ontario Convention & Visitors Bureau Sandra Rose Henry Shannon Chaffey College Chris Taylor HMC Architects Chaffey College Support Staff Lisa C. Nashua, MSLM Executive Director, Foundation and Governmental Relations Marie Baston Foundation Coordinator Lissa Napoli Administrative Assistant II Sharon Awad Scholarship Program Assistant Dear Chaffey College Student: Thank you for your interest in applying for a Chaffey College Foundation Scholarship. We are proud to provide scholarships to qualifying and deserving students. Through the generosity of local businesses, professional associations, and individuals, the Chaffey College Foundation is able to offer scholarships to students pursuing their educational goals. Please read the following valuable information to make sure you are fully aware of the requirements for these scholarship opportunities. It is important that you follow all directions and fully complete the application packet. You must be a registered and current Chaffey College student. All Chaffey College Foundation Scholarships will be awarded in the Academic Year. Recipients receive a scholarship account card that can be used to purchase books and supplies at the college bookstore, or at the Cashier s Office to pay for any fees or charges related to enrollment. Any scholarship recipient that is dismissed from, or drops out of Chaffey College will forfeit their scholarship. Applications will be accepted during the fall and spring semesters of each academic year. The Chaffey College Foundation Scholarship Committee reviews applications twice a year for awarding. Scholarship applications for the spring semester scholarship round of the academic year will only be accepted between November 1, 2015-January 20, Applications are being accepted in the Foundation Office (MOD-1 Rancho Campus), the Fontana Campus Bookstore (FNAC- 129), and the Chino Campus Bookstore (CHMB-149). *You must submit a new application for each semester (fall or spring) in order to be considered for scholarships for that semester. Your application will be evaluated according to the following general eligibility criteria: 1. Demonstrated Financial Need 2. Minimum Cumulative GPA of 2.5 and/or Evidence of Significant Improvement in Academic Performance. 3. Personal Statements 4. Educational Goals 5. Community and/or College Involvement 6. Transcripts: IF this is your first semester here at Chaffey College you will need to submit an unofficial transcript from the previous school you attended. You can visit your former school to obtain your transcripts or go to to set up an account and receive your transcripts in the mail. Fees may apply. (Page Over)

2 Please include as much information as you feel comfortable sharing. Remember that this is your ONLY opportunity to share with the scholarship committee WHY you need this scholarship and since they will not have the opportunity to meet with you at this time make sure to tell them about yourself in the essay portion of this application. Please feel free to add additional word documents if necessary. Sincerely yours, Lisa C. Nashua, M.S.L.M. Executive Director Foundation & Government Relations

3 For Office Use Only Date & Time Received Chaffey College Foundation Scholarship Application This scholarship is open to all Chaffey College students regardless of citizenship or residency status. PERSONAL INFORMATION Type or print legibly in blue or black ink ONLY. An incomplete application will result in disqualification. Student ID Number: Gender: Male Female New Student Continuing Student Have you received a Foundation Scholarship in the past? Full Legal Name: First Middle Initial Last Date of Birth (mm/dd/yy): Did either of your parents ever attend college? Yes No Did either of your parents or any other member of your immediate family ever attend Chaffey College? Yes E- mail address: (E- mail confirmations will be sent out regarding this scholarship application as well as information of other available scholarships.) No Permanent Address: Number & Street Apt. # City State Zip Code Mobile Phone ( ) - Home Phone Number ( ) - Alternative Phone Number ( ) - ACADEMIC INFORMATION Total units earned to date: Transferable units earned: Cumulative GPA: Current enrollment status: Part- time Full- time Less Than Half Transferring: Fall Spring Summer (Minimum 6 units) (Minimum 12 units) Declared or Expected Major: (According to your education plan) *Have you taken any the following courses as of today? 1. CISPROG 1: Intro to Computer Programming Yes No 2. CISPROG 3: Fundamentals of Visual Basic Programming Yes No 3. CISPROG 403: Advanced Basic Programming Yes No 4. CIS 431: Project Management for Information Technology Yes No *If you are a nursing major, are you in the actual nursing program as of today? Yes No Work experience (list last four jobs only) WORK EXPERIENCE/ EXTRA CURRICULAR ACTIVITIES Online application available at:

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5 3 FINANCIAL INFORMATION Are you, or have you ever been a foster youth? Yes No If yes, are you able to provide legal documentation confirming this information? Yes No Have you completed the Free Application for Federal Student Aid (FAFSA) form? Yes No If yes, what is the status: Have you ever received a scholarship as a Chaffey College student? Yes No If yes, please list which scholarship(s): Are you a veteran of the U.S. armed services? Yes No If yes, are you receiving GI benefits? Yes No Are you a registered DPS Student? Yes No Are you a CARE Student? Yes No Are you an EOPS student? Yes No Are you part of the CalWORKs program offered through Chaffey College? Yes No For SECTIONS 1 AND 2: Do NOT fill out both sections, choose one or the other SECTION 1. INDEPENDENT APPLICANT: (This section applies to you if you were born before January 1, 1990) Are you currently receiving Government Assistance? If Yes, (check all that apply below) Yes No CalWORKs, CalFresh, or Medical Are you receiving SSI (Supplemental Security Income)? Yes No Are you receiving GA (General Assistance)? Yes No Economic Status: is your household annual income less than $12,525 (for a single person); $16,875 (for a couple adding $4, per dependant child)? Yes No Are you a Displaced Homemaker? An individual who has worked primarily without receiving compensation to care for a home and family, and for that reason has diminished marketable skills. Yes No Please estimate your TOTAL annual gross household income: $ SECTION 2. DEPENDENT APPLICANT: (This section applies to you if you are under 24 years of age unless you are a Graduate Student, are married or have dependents other than a spouse, are an orphan/ward of the court, or are a veteran of the U.S. armed services) Parent(s) /Guardian(s) Marital Status: Single Married Separated Divorced Widowed Mother s/guardian s occupation: Father s/guardian s occupation: Parents/Guardians TOTAL combined annual gross household income: $ Do your parent(s)/guardian(s) contribute to your educational expenses? Yes No Do you live with your parent(s)/guardian(s) during the academic year? Yes No Number of people your parent(s)/guardian(s) can claim as dependents on their tax return (include yourself): How many dependents are currently in college (include yourself)? Are either parent/guardian a Veteran? Online application available at:

6 Certification and Authorization: Applicant must read and sign below to be eligible. All of the information on this application is true and complete to the best of my knowledge. I certify that I meet all eligibility requirements as specified in this application. I understand that I may or may not receive a scholarship and that filling out this application does not guarantee that I will be selected as a recipient of a Chaffey College Foundation scholarship. I understand that all application materials become the property of the Chaffey College Foundation, cannot be returned, and will be treated as confidential. Any knowingly false statements on this application may disqualify me from consideration for a scholarship. I hereby authorize the Chaffey College Foundation to utilize information about my application, thank you letter, and my likeness for public relations purposes, publicity, or other scholarship opportunities. 4 Signature (Required) Date Online application available at: