SCHOLARSHIP APPLICATION FORM

A.     General Information

Please read the following instructions, print, and complete the application.  The information requested should be typed or printed legibly.  DEADLINE:  Applications must be postmarked no later than midnight, March 15th before the following academic year.  Applications submitted after this date will not be considered.  The REFORMA Scholarship is awarded to students who qualify for graduate study in library science and who are citizens or permanent residents of the United States.

Date                                                                        

Last  Name:

  ______________________________________________________________________

First Name:

  ______________________________________________________________________

Middle Initial:

  ______

Phone:

Area Code _______   Day Phone ____________________   Evening Phone _____________

Present Address:

Street ______________________________________________________________

 

 City ________________________   State _____   Zip Code ____________________

Permanent Address:

Street ______________________________________________________________

 

 City ________________________   State _____   Zip Code ____________________

 

 

      Are you a U.S. citizen?      Yes _____  No _____  If not, what is your residency status?                                

      List any foreign languages you speak, read or write and indicate your proficiency:

A = fluent               B = Good                      C = Fair

LANGUAGES

SPEAK

READ

WRITE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     List in order beginning with most recent, all junior colleges, colleges, universities, graduate and professional
schools at which credit has been earned.

Name of Institution

Dates Attended

Degree

Major

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

B.                 Employment History

Chronological record (beginning with most recent) of employment activities.  (Leave no significant gaps unexplained)

Dates

Employer

Nature of Work

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C.           Personal Statement

    Please write a concise statement (2-page limit) demonstrating your past commitment to serving the Spanish-speaking community.

 

 D.         Recommendations

Print out two copies of the reference form.  These should be given to persons (excluding family) who are well-acquainted with your intellectual abilities, educational background, and personal character.  List the names and addresses below of those to whom you have given the recommendations forms.  An application will not be considered unless there are two recommendations postmarked 
no later than midnight, March 15th.

1.

 

2.

 

E.  List below the ALA – accredited Library education programs to which you have applied.  Keep in mind it is not necessary to have received a notice of acceptance at the time of application.

F.  The Scholarship Committee will need official transcripts from all colleges attended.  Photocopies will not be accepted.

G.  The Scholarship committee will also need a current resume.


I have read the instructions for filing an application and I certify that the above statements are correct and complete.  I understand that the REFORMA Scholarship Committee will maintain this information as confidential.

SIGNATURE                                                                                       Date                                                  

Please return this application by March 15th to:

REFORMA Scholarship Committee
Ramona Grijalva, Chair
P.O. Box 7543
Tucson, AZ 85725
ramonagrijalva@yahoo.com

 

How did you learn of this scholarship?                                                                                                                                          

                                                                                                                                                                                                                 

                                                                                                                                                                                                                 

 

 

© 2009 REFORMA