The Ernani Bernardi Scholarship - The City of Los Angeles

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2012 City of Los Angeles - Bernardi Scholarship Application Part 1: Personal Information (all information is confidential) Name: ________________________________________________________________________ Last Name First Name MI. Birthdate: ______/_______/______ Gender (check all that apply): ___ M ___F Mo Dy Yr Ethnicity (check all that apply): White: __ African American: ___ Native American: __ Latino/Hispanic : __ Asian/Pacific Islander:__ Mailing Address: ______________________________________________________ ________________________________________________________________________ Home Telephone: (____) _________ Mobile: (____) _________ Email address: ___________________________________________________________________ Part 2: Your Education School (currently attending):______________________________________________________________ School Address: ________________________________________________________________________ Class standing (please check one): High School Senior: ___ College Freshman: __ College Sophomore:___ College Junior: ___ College Senior: ___ Major(s): ___________________________ ___________________________ Current Cumulative GPA: _____ Expected Graduation Date: _____/______ Mo. Yr. If High School Student – what college will you be attending in the fall? Reminder – Must be a higher education institution within the City of Los Angeles. ________________________________________________________ Part 3: Extracurricular Activities Honors and Awards Received (include year): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
Activities, Sports, Club, Leadership Positions: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Employment Are you employed? Y___ N____ Employer: __________________________________________ Position: ______________________ How many hours of work per week? _________ Part 4: Financial Information Please state your projected college expenses for 2012-2013 College Year Your Income College Expenses Parent Contribution: ________________ Yearly Tuition: _____________ Employment: ___________________ Books: _________________ Cal Grants: ____________________ Supplies: ________________ Board of Governor Fee Waiver: Room/Board: _____________ ______________ Other Scholarships: Other Expenses: ___________ ____________________ Total: ________________________ Total: __________________ Part 5: Personal Statement (please reply on separate paper. Typed. Double spaced. 2 pages max.) Please give a brief response to the following questions: 1) Why is the pursuit of education important for you? 2) What obstacles do you face as you pursue your education? 3) How will your education improve the quality of life for those living in the Northeast Valley? 4) The Northeast San Fernando Valley faces environmental challenges. What is the most significant challenge and what do you think YOU can do to address these challenges? CERTIFICATION I certify that all the information provided on this application is accurate to the best of my knowledge. I am aware that I will be notified by mail regarding my application and award; I understand that if awarded, the scholarship award will be sent directly to the college I am or will be attending. In addition, if awarded, I understand that there is no guarantee of renewal and must reapply for the scholarship each year. Recipients will be notified by. An incomplete application will not be reviewed. Failure to sign this certification will result in the automatic ineligibility of my application. Print: _____________________________________ Date: _____________ Signature: _________________________________
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The Ernani Bernardi Scholarship - The City of Los Angeles

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