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1 Page 1 of 5 For recent graduates, College or University students of Art, Film, Film Production, Music, Technology/Software, Photography, and other creative programs. SpaceLA is offering different types of scholarships for 2011/2012 academic year: General scholarships, low income scholarships, minority scholarships, merit or high ability scholarships, and scholarships for students with disabilities. PERSONAL INFORMATION Last Name First Name SS# ADDRESS City State Zip TELEPHONE NUMBERS Home Cell EDUCATIONAL INFORMATION High School Name City State Year graduated (or will graduate) GPA College/University Name City State Year graduated (or intend to graduate) GPA Major or interested Major Full Time Part Time

2 Page 2 of 5 APPLICANT STATUS High School College Assoc. Degree Bachelors Masters SPECIAL NEEDS Low Income Disabilities Minority Special Merit/High Ability Other STUDENT S CITIZEN STATUS US Citizen (US National) Eligible Non Citizen DRUG CONVICTIONS Yes No EXTRA CURRICULAR ACTIVITIES Internships, employment, community involvement, special skills or awards. Write a minimum of 250 words explaining your involvement which you have held in the past 3 years, or describe a leadership experience in which you made a difference on Campus or in your community. CAREER GOAL Write short description, or your aspirations and statement of motivation essay.

3 Page 3 of 5 INTERESTS (check all that apply Art: Design, technology, computers, software Film: Film production, editing, directing Music Photography Management SPECIAL ACHIEVEMENT Honors and Recognition. List any awards, honors, or scholarship you have received in the past 2 years. Nomination letter (to be completed by a school or department official or teacher) *To the teacher/faculty member Please provide your candid assessment of the Nominee s academic performance and professional promise. OPTIONAL Letter of Recommendation, From a current or past instructor/mentor. He/she should be familiar with your artistic qualifications and include it in recommendation letter. Any additional information you would like to submit to support your submission. As an intern at SpaceLA, you will have real responsibility, real work, and opportunities to jumpstart your career. We help with the job placement. It s a wonderful, unique experience, which you ll never find in a classroom. Imagine millions of people seeing your work on our live web site. FAMILY FINANCIAL INFORMATION Adjusted Gross Income of Parent(s)/Guardian(s) from IRS 1040, if applicable: Under $30,000 $31,000 to $50,000 $51,000 to $75,000 $76,000 to $100,000 Over $100,000 Applicant s gross income $

4 Page 4 of 5 I hereby certify that the information I have submitted as correct. I authorize the release of this information to SpaceLA Scholarship Committee and will provide additional information or verification upon request. If granted the scholarship, I agree to the publication of my name and likeness by SpaceLA and agree to the conditions established for this scholarship award. Parent(s) / Guardian(s) signature, if under 18 Applicant s signature Date submitted MAIL COMPLETED APPLICATION: SpaceLA Inc. Scholarship 6520 Platt Avenue, P.M.B. 910, West Hills, CA All applicants will be notified by letter of their eligibility and the results of their application within 45 days.

5 Page 5 of 5 CONDITIONS OF ENTRY SpaceLA selects final candidates based on the following criteria: Eligibility Financial need Commitment to leadership/community Minority status Merit or high ability Special needs/disabilities General Essay/motivation College student nominees must be enrolled in the academic year with a GPA of 3.0 or above. All decisions are final. The names of winners may be published on our website. Winners of scholarships agree to allow the free use of their name, photograph, and general location for publicity and news purpose in connection with the scholarship program. Applicants will be evaluated on the basis of academic achievement, creative and technical ability, community involvement, and other experiences. Low income and Special Needs applicants will be evaluated by our committee on a case by case study. You must furnish any other applicable transcript or letters of recommendation you would like the Scholarship Committee to consider. All applicants will be notified by letter of their eligibility and results.

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