(3 pages)

Instructions:  Please provide all of the information requested on this application form.  Mail the form with the required attachments to the above address.  The application must be received no later than May 31st.  Incomplete applications and applications received after the specified date will not be considered.

Eligibility Criteria:  In order to be eligible for this scholarship the individual applying must be of Portuguese or part Portuguese ancestry; or be a member of the Hawaii Island Portuguese Chamber of Commerce or be sponsored by a member; and be a current or former resident of the Island of Hawaii; and be enrolled or accepted for enrollment at an accredited college or university.

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Applicant Information:

(Please print or type)

1.      Name:              ___________________________________________

2.      Address:           ___________________________________________

                                ___________________________________________

3.      Tel. No.            ___________________________________________

		Yes	No
4.	Are you currently enrolled in an accredited college or university?	□	□
	If YES, enter the name of the college or university (attach proof of enrollment)? ______________________________________________
5.	If you are not enrolled at an accredited college or university, have you been accepted for enrollment by an accredited college or university?	□	□
	If YES, enter the name of the college or university (attach proof of acceptance)? ______________________________________________
6.	Are you of Portuguese or part Portuguese ancestry?	□	□
	If YES, please attach a copy of your birth certificate and go on to question 9.
7.	Are you a member of the Hawaii Island Portuguese Chamber of Commerce?	□	□
	If YES, go on to question 9.
8.	If your answer to both question 6 and 7 was NO, a member of the Hawaii Island Portuguese Chamber of Commerce must sponsor your application.
	Do you have a sponsor for your application?	□	□
	If YES, enter your sponsors’ name? ______________________________________________
9.	Do you currently reside on the Island of Hawaii?	□	□
	If NO, have you ever been a resident of the Island of Hawaii?	□	□

Selection Criteria:

The items listed below must be submitted as attachments with this application form.

A.      If you are enrolled in a college or university, attach your college/university transcript, current through the last school semester.  If you are not enrolled in a college or university, attach your high school transcript.
 

B.       Attach your most recent federal income tax return.  If you did not file a return because your are claimed as a dependent on someone else’s return, attach the most recent federal income tax return on which you are claimed as a dependent.

C.      Attach a detailed description of the community service, school service and school extra-curricular activities in which you have been involved.  Examples of these would be volunteer work in and out of school, clubs and sports. 

D.      Attach a narrative essay (approximately 500 words) describing your intended course of study, your short and long-term career goals and how your education will help you to achieve your goals.

E.       Attach letters of recommendation from three persons not related to you.

F.       Attach a detailed description of your significant accomplishments, such as awards and honors received and offices held.

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Certification:

The undersigned applicant certifies that the information on and attached to this application is true and correct to the best of the applicant’s knowledge.