Scholarship Application Form

Please read and follow the instructions below carefully prior to submitting your application.

These are items you will need to attach to your application form, so please make sure to gather them:

• A 650-750-word essay about your college/career goals, overcoming hardships, volunteer work, employment, awards, personal accomplishments and experiences that make you worthy of scholarship consideration. Include your particpation in Samoan Community Development Center and/or the Sunnydale Boys/Girls Club.
• A graduation photo or quality headshot of yourself
• A Letter of Recommendation from a community leader, for example: the SCDC (Samoan Community Development Center) Staff, the Sunnydale Boys/Girls Club Staff or YMCA staff.
• A Letter of Recommendation from a teacher
• A Copy of your school transcripts

All questions with a red asterisk * are required for form submission. You will have the option to "save" this application form in-progress and continue filling it out later. To save your form for completion later, hit the red "Save" button at the bottom of the screen. You will have an option to copy your application link (green button) for posting into your web browser later... or input your email address, and the link will be emailed to you.

Post-Application-Submission:

If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation. Additionally, recipients are required to attend an award ceremony on Saturday, July 26, and provide proof of acceptance/attendance of college/university institution.

Optional Information: 

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards. However, providing this information may increase your opportunities for scholarships where donors have asked that priority consideration be given to students meeting certain demographic criteria (such as minority status, parent's place of employment, area of study, etc.)

If you are concurrenty enrolled at a community college, please answer the questions below:

Your essay should be 650 - 750 words. You should address in your essay: your college/career goals, your ability to overcome in the face of hardship, choice of major or career interest, what you intend to do with your education, and why a scholarship is important to you. Include your participation in the Sunnydale Boys/Girls Club, or Samoan Community Development Center, community service or volunteer work, employment, awards, academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.

In order to share information about the Bold City Coffee Company/Greater Life Church Scholarship with the community and funders, we request your permission to use and display information, interviews, pictures and/or videotapes of you recorded by or on behalf of the Bold City Coffee Company/Greater Life Church Scholarship for any/and all events. These items may be used on our website, on our social media channels, and in our marketing, advertising and promotional materials, including our brochures and other print materials and videos.
 
Media / Web Consent
I hereby authorize Bold City Coffee Company/Greater Life Church to use, publish and display the following information on its website, in social media, and in its marketing and promotional materials, including brochures, newspaper and magazine articles, advertisign, and on television and other media presentations concerning the Bold City Coffee Company - Greater Life Church Scholarship:  

• Student’s Name
• Student’s Individual Photo
• Group photo including Student
• Student’s work related to the programs 
• Student information including:
  
  • Biographic: First name, gender, ethnic background, hometown
  • Educational: High School, college, intended major, affiliated programs
  • Brief summary of relevant personal circumstances, interests, and goals

Release
I hereby generally and completely release Bold City Coffee Company/Greater Life Church from any claims that may result from use of the above information in accordance with the terms of this Agreement. I understand that this is a full, complete, and final general release of any claims and agree that it applies to all unknown, unanticipated and undisclosed claims. I have read and fully understand the contents of section 1542 of the Civil Code of the State of California, and that section and the benefits thereof are expressly waived. Section 1542 reads as follows:

"Section 1542. (General Release - Claims Extinguished.) A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor."

Please sign below to indicate your consent.

By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

Unable to submit the form? Scroll back up and make sure you have filled out all of the required information (indicated in red).

Bold City Coffee/Greater Life Church are committed to equal opportunity in employment and education. We do not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.