2024 CLCCCF/CCI Application Form

2024 CCI Scholarship Application

Applications will be accepted April 15th - May 31, 11:59pm PST. Students must reside in one of the five counties of the California Central Coast: Santa Cruz, Monterey, San Luis Obispo, Santa Barbara, Ventura
Personal Information*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Preferred Pronouns
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence*
County
Alternate Address (if mailing address is PO Box)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Current High School or College*
City*
Grade Level or Year*
GPA*
Prospective College*
College Major/Graduate Program*
Click here if your Major falls into a STEM category - Science, Technology, Engineering or Mathematics
Alternate Contact*
First Name/Last Name
Alternate Contact Ph. Number*
Please enter a valid phone number.
Alternate Contact Email*
example@example.com
Please use the following website to find your CA State Senator & Assembly Member:

findyourrep.legislature.ca.gov
Who is your CA State Senator?*
Please use the link above to identify your Senator
Who is your CA State Assembly Member?*
Please use the link above to identify your Assembly Member
Personal Statements
Please provide a short biography of yourself, including your education, activitites, and volunteer experience (250 word limit)*

0/250
Which personal experiences have influenced your decision to pursue higher education and how will these experiences help you with your career goals? (500 word limit)*

0/500
If selected, how will this scholarship affect you? (500 word limit)*

0/500
Upload Required Files
Resume*

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School Transcript*

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1st Recommendation Letter*

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2nd Recommendation Letter*

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Click here to download the Visual/Audio Image Release Form. Please fill out and upload to the right.
Visual/Audio Release Form*

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Acceptance Letter (if applicable)

Prospective undergraduate, transfer, and graduate students
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Additional Files

You may upload multiple files.
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Terms
By checking this box clicking the submit button below, I agree to the following terms & conditions:
"I certify that all information submitted with this application is true and correct to the best of my knowledge. Furthermore, I have uploaded all required components of the application including a resume, two recommendation letters, a school transcript, a picture, and the completed audio/visual image release form. "
Applications will be accepted April 15th - May 31, 11:59pm PST
Should be Empty:

2024 CCI Scholarship Application

Personal Statements

Upload Required Files

Terms