Scholarship Application Name* First Last Last 4 digits of your social security #*RequiredDate of Birth* MM DD YYYY Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone #*Email* Enter Email Confirm Email Country of Birth*Legal Status*U.S CitizenPermenant ResidentOther (Please specify)If you answered other, please specifyA#Permanent Residents of the USA onlyEthnicity*(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:University of Michigan-Dearborn: Scholarship: $3kWayne State University: $3kMichigan State University: Scholarship: $2kUniversity of Michigan-Ann Arbor: Schoarship: $2k (Undergraduate Students)University of Michigan-Ann Arbor: Scholarship: $1k (Graduate Students)Other Universities-Scholarship: $1kIf you answered other, please specifyGPA*Please enter a number from 3.5 to 5.ACT test scoreYou may submit either the ACT or ASTAST test scoreYou may submit either the ACT or ASTProposed Field of Study*Are you able to attend the mandatory meeting with the scholarship recipients on Friday, October 30th, 2020 at 5:30 p.m. LAHC Community Center: 5275 Kenilworth St. Dearborn*Attending the meeting is mandatory. If you are unable to commit, we advise you not to proceed further with the application.YesNoAre you able to attend the Awards Ceremony Scheduled for November 13th, 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.YesNoIf you answered No to any of these two questions, please explainAre you receiving any other scholarships or other form of financial assistance?*YesNoIf you answered yes, please list any other scholarship (s) /financial assistance you are currently receiving or expect to receiveFAFSA “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?*YesNoIf yes, when?How did you learn about this program?*(LAHC staff, website, flyer, school, media outlet....)Please upload Required Documents belowEssay: (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. Accepted file types: jpg, gif, png, pdf.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. Accepted file types: jpg, gif, png, pdf.Note: Letters of RecomendationLetters should be from faculty members familiar with the student’s character and academic performance. Letters must be recent and must include the contact information such as phone number & email address of the faculty member. Students are highly encouraged to attach their letters of recommendation to the scholarship application. Although this is not the preferred method, faculty members who still wish to send their letters directly to us may do so through this secure link: www.lahc.org/lor. If your teacher (s) will be sending the letter (s) directly to us, please attach a note to your application 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 RecommendationOnly 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. Accepted file types: jpg, gif, png, pdf.Second Letter of RecommendationOnly 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. Accepted file types: jpg, gif, png, pdf.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. Accepted file types: jpg, gif, png, pdf.Release Statement and AcknowledgementI 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 NameBy typing my name below, I am electronically signing this application.