Scholarship Application

Name*

First Last

Last 4 digits of your social security #*

Required

Date of Birth*

MM

DD

YYYY

Address*

Street Address Address Line 2 City State ZIP Code

Cell Phone #*

Email*

Enter Email Confirm Email

Country of Birth*

Legal Status*

If you answered other, please specify

A#

Permanent Residents of the USA only

Ethnicity*

(Arab American, African American, White, Asian, Hispanic...) This info is only used to track the various ethnic groups we proudly serve . LAHC does not discriminate against any race, religion, gender or ethnic background.

Name of Academic Institution you are CURRENTLY attending*

Academic Institution you plan on attending*

[Note that the monetary value of the scholarship is determined based on the matching agreement (s) we have in place with various universities. If you choose to switch colleges after applying for this scholarship, the value of the scholarship received will change accordingly]. Choose One:

If you answered other, please specify

GPA*

Please enter a value between 3.5 and 5.

ACT test score

You may submit either the ACT or AST

AST test score

You may submit either the ACT or AST

Proposed Field of Study*

Are you able to attend the mandatory meeting with the scholarship recipients on May 20th at at 5:30 p.m. at the LAHC office in Dearborn?*

Attending the meeting is mandatory. If you are unable to commit, we advise you not to proceed further with the application.

Are you able to attend the Awards Ceremony Scheduled for May 28th, 2020 at the Henry Hotel?*

Attending the awards ceremony is mandatory. If you are unable to commit, we advise you not to proceed further with the application.

If you answered No to any of these two questions, please explain

Are you receiving any other scholarships or other form of financial assistance?*

Yes
No

If you answered yes, please list any other scholarship (s) /financial assistance you are currently receiving or expect to receive

FAFSA “EFC” score appearing on Student Aid Report*

Please list any extracurricular activities/volunteering opportunities/ community involvement.*

Have you ever received the LAHC Scholarship in the past 3 years?*

Yes
No

If yes, when?

How did you learn about this program?*

(LAHC staff, website, flyer, school, media outlet....)

Please upload Required Documents below

Essay: (Type your 500 words essay in the filed below)*

Substance abuse is an epidemic that has been plaguing our community for years. Teenage drug abuse is one of the largest problems in society today and continues to grow every year. Peer pressure, low self-esteem, escape, self-medication, boredom, instant gratification and rebellion… are some of the reasons why youth turn to drugs. How do you think we as a community need to address this epidemic and what role should youth take in this effort?

Academic Transcript*

(Only scanned copies of original document will be accepted and must be in PDF or JPG format). Please DO NOT USE numbers or special characters such as (, . 1. 2, ^, &* &...) IN THE FILE NAME. We won't be able to access the file.

Student Aid Report*

(Scanned Copy must be in PDF or JPG format Only) -Please DO NOT USE numbers or special characters such as (, . 1. 2, ^, &* &...) IN THE FILE NAME. We won't be able to access the file.

Note: Letters of Recomendation

Two letters of recommendation: Letters should be from faculty members familiar with the student’s character and academic performance. Letters must be recent and must be on letterhead of the institution. Students are highly encouraged to attach their letters of recommendation to the scholarship application. Although this is not the preferred method, professors and faculty members who wish to send their letters directly to us may do so through this secure link: www.lahc.org/lor. If your professor (s) will be sending the letter (s) directly to us, please attach a note below to that effect. Please note that we are not responsible for any letters that are not received, nor that we can provide you with updates in this regards.

First Letter of Recommendation

Only electronic copies submitted via this form are accepted. We can not accept letters sent to us via mail or email. Copies must be in PDF or JPEG format ONLY. Letters must be printed on college letterhead and signed by the professor and include contact information- Please DO NOT USE numbers or special characters such as (, . 1. 2, ^, &* &...) IN THE FILE NAME. We won't be able to access the file.

Second Letter of Recommendation

Only electronic copies submitted via this form are accepted. We can not accept letters sent to us via mail or email. Copies must be in PDF or JPEG format ONLY. Letters must be printed on college letterhead and signed by the professor and include contact information- Please DO NOT USE numbers or special characters such as (, . 1. 2, ^, &* &...) IN THE FILE NAME. We won't be able to access the file.

ACT or SAT

(Scanned Copy must be in PDF or JPG format Only) -Please DO NOT USE numbers or special characters such as (, . 1. 2, ^, &* &...) IN THE FILE NAME. We won't be able to access the file.

Release Statement and Acknowledgement

I hereby certify that all information provided on the LAHC Scholarship Application is true and complete to the best of my knowledge. I acknowledge that if I am selected to receive a scholarship, it is my responsibility to understand the requirements of the specific scholarship. The released education records and all other information attached to this application will be used for the purposes of evaluating my eligibility to receive scholarships, correspondence with scholarships donors, academic institutions, and press releases relating to scholarships recipients. I expressly authorize the LAHC to disclose my education records for these purposes. All submitted information becomes property of the LAHC and will not be returned to the scholarship applicants. Additionally, I give the LAHC permission to use my Photograph /video for the purpose of publicity associated with scholarships awarded. This release is intended to discharge any and all claims and demands arising out of or in connection with the use of photography/video in which my image appears, including any and all claims for libel or invasion of privacy. I hereby grant the LAHC the ownership and full use of any photographs/videos that are taken.

Electronic Signature of scholarship applicant: First-Last Name*

By typing my name below, I am electronically signing my application.

Electronic Signature of Parent/ Legal Guardian if student is under the age 18: First-Last Name

By typing my name below, I am electronically signing this application.