REFORMA Scholarship Application Form

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 15^th 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 ____________________

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

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

A = fluent B = Good C = Fair

LANGUAGES	SPEAK	READ	WRITE

7. 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

1. Please write a concise statement (2-page limit) about why you believe serving the needs of the Spanish-speaking people in the United States is important.

2. 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 15^th.

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

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