2026 CLCCCF/CCI Application Form

2026 CLCCCF/CCI Application Form

Applications will be accepted March 1 - April 30, 11:59pm PST. In line with our mission, the scholarship program will offer financial assistance to students who consider the Central Coast their home.
Personal Information*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Preferred Pronouns
Mailing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address for Scholarship Check (check dispersement Summer 2026)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
County of Residence*
County
Alternate Address (if mailing address is PO Box)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
High School*
City*
College (Current or Prospective)*
City*
Grade Level or Year*
GPA*
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.Format: (000) 000-0000.
Alternate Contact Email*
example@example.com
Who is your CA State Senator?*
Please use the link above to identify your Senator
Please use the following website to find your CA State Senator & Assembly Member:

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

0/250
Personal Statements
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
Resume*

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School Transcript*

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Upload Required Files
1st Recommendation Letter*

Letter must be signed with a "wet" signature by the author and dated within the last 12 months
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2nd Recommendation Letter*

Letter must be signed with a "wet" signature by the author and dated within the last 12 months
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Acceptance Letter (if applicable)

Prospective undergraduate, transfer, and graduate students
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Visual/Audio Release Form*

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Additional Files

You may upload multiple files.
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Click here to download the Visual/Audio Image Release Form. Please fill out and upload to the right.
By checking this box, 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. "
By checking this box, you agree: If a scholarship is awarded, you will submit a headshot and a 60 second video of who you are, what you are studying, where you are going to school, and why this scholarship is important.
Applications will be accepted March 1, 2026 - April 30, 2026, 11:59pm PST
Should be Empty:

2026 CLCCCF/CCI Application Form

Personal Statements

Upload Required Files