Roger Haley Scholarship Application

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Date of Birth*

Parental Information

Father's Name/Occupation*

Mother's Name/Occupation*

Family Information

Number of Siblings or Children*

Ages

Number of Sibling(s) in college now

Will you be the First in your Family to Attend College?*

Yes
No

Are you Living on your Own?*

Yes
No

Will you be Paying your Own Expenses?*

Yes
No

Previous Year's IRS Stated Yearly Household Income*

Are you Receiving/Expecting Other Financial Aid?*

Yes
No

If Yes, From Where and how Much?

Academic Information

Name of College and Program*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Academic Reference*

First Last

Scholastic Average (GPA)*

Upload Your Transcript(s)*

Please upload a scan (or photographs) of your high school transcripts. PDFs and JPG files are accepted.

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 30 MB.

Three References

(i.e. Academic, Work, Extra-Curricular Activity, etc.)

Name*

Title*

Phone*

Name*

Title*

Phone*

Name*

Title*

Phone*

Personal Accomplishments and Goals

Short Autobiography, including your family background and personal interests.*

List any honors, awards, or recognitions have you received?*

List community service projects or activities in which you have participated that have benefited your community and the number of hours spent on each project.*

List all jobs, sports, and/or other extracurricular activities that you have been a part of. Please include dates when you started and stopped each.*

In 1 paragraph, describe what you consider to be the single most important project or activity in which you have participated. Why is it the most important and what have you taken from it?*

In 3 paragraphs, describe your future goals that you have for yourself in 1 year, 5 years, and 10 years.*

Consent*

I hereby certify that the statements contained in this application are true, accurate and complete. I understand and agree that any funds I may receive from The Chula Vista Firefighter’s Foundation must be used for educational purposes and that I will provide proof of such if requested to do so.

Note: Official transcripts must be submitted to have a complete application.

Roger Haley Memorial Scholarship

Personal Information

Parental Information

Family Information

Academic Information

Three References

Personal Accomplishments and Goals