CC Community Scholarship Application

Culver City Community Scholarship Application
Welcome to the Culver City Community Scholarship Application!

Due Date: February 3rd, 2021

Please read these directions carefully and entirely before starting your application. In addition to reading these instructions, please watch the instructional video, found here: https://vimeo.com/485344996/db53b074c6.

This application is split up into 6 parts:
1. Applicant information
2. Applicant Questionnaire
3. Parent/Guardian Questionnaire
4. Media Release Agreement
5. Essay Questions
6. Recommender Information
The parent/guardian questionnaire and the media release agreement (unless the applicant is over 18) must be filled by a parent/guardian, NOT the applicant.

All questions marked with a red asterisk (*) are required. You will not be able to submit your application without answering them first. That being said, please answer every question you can (including those that aren't required) to get the best scholarship consideration possible.

Saving: THIS APPLICATION DOES NOT AUTOMATICALLY SAVE YOUR RESPONSES. If you would like to save your progress and continue working on your application later, please follow these steps to ensure that your progress isn't lost:
- Scroll down to the bottom of the page and click "Save"
- You will then be prompted to create an account with JotForm. Click the tiny blue words at the bottom of the window that say "Skip Create an Account"
- Enter your email address and click "send link"
- Before closing out of the application, check to make sure you received an email from JotForm. This email will contain a link to continue working on your application.
- When you want to return to the application, click on the link in the email that was sent to you. You may then continue working on your application.
Please note that you must follow this process everytime you save your work. Any progress that you make on the application after saving will be lost unless you save the form again.

Letters of Recommendation: At the very end of the application, you will be prompted to enter the names of your two recommenders (please click on the Recommender Information tab for more information). Once you submit your application, your recommenders will both be emailed with instructions on how to submit your letter. Remember to talk to ask your recommenders before entering their names on this application. Note: Your Recommenders will not be emailed until after your application is submitted. So even though the deadline for the application is February 3rd, the deadline for letters of recommendation is March 1st. Your application will not be considered complete until all elements have been received, including your letters of recommendation.

Submission: Although this form is electronic, you must turn in a physical copy to be reviewed. Once you submit your application, you will be emailed a PDF attachment containing your response. Please out print this attachment, and use one of the following options to turn it in:
1. Drop it off at the front office of Culver City High School in the scholarship mailbox. You may only use this option when the front office is open, so please confirm their hours ahead of time.
2. Mail it to the following address: Culver City Community Scholarships C/O Culver City High School, 4401 Elenda Street, Culver City CA, 90230
To ensure that your application is received on time, please send in the physical copy immediately after submitting this online application.

If you have any questions that haven't been answered by these instructions or the video, please send an email to cccommunityscholarships@gmail.com.

Applicant Information
Full Name *

First Name Middle Initial Last Name
PERSONAL Email Address *
example@example.com
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
I certify to the best of my ability that the information in this application is complete and correct to the best of my knowledge. I am aware that any false statement may result in the disqualification of my application for the Culver City Community Scholarship Award.
Today's Date *

Month Day Year
Date
Applicant Name *
Applicant Signature *

Clear

Media Release Agreement
I agree to allow the use of my son’s or daughter’s name, photograph, video or still to appear on the Culver City Community Scholarship website or on the Culver City Unified School District website. For example, photographs and articles about the scholarship program and/or the scholarships awarded may appear in local newspapers or Culver City Unified School District publications. The photographs and articles may or may not personally identify the student. The photographs and/or videos may be used by the Culver City Community Scholarship Fund in subsequent years. I waive all claims against the Culver City Community Scholarship Fund, its Board and officers to indemnity and hold harmless the Culver City Community Scholarship Fund et al. from any and all liability, claims, demands, causes of action or judgments due to the use of the applicant’s name and photograph.
Are you (the applicant) 18 or older? *

Yes No
This agreement must be completed by your parent or legal guardian

I agree to allow the use of my son’s or daughter’s name, photograph, video or still as stated in the Media Release Agreement I do not agree to the use of my son’s or daughter’s name, photograph, video or still asstated in the Media Release Agreement.
Applicant Full Name

First Name Last Name
Parent Signature

Clear
Today's Date

Month Day Year
Date
I am at least 18 years of age and I have carefully read this document. I warrant that I understand and content the foregoing authorization, release and indemnity. My signature, heron, is my own free act and it is my intention to be legally bound hereby.

By my signature below, I agree to the use of my name, photograph, video or still as stated in the Media Release Agreement. By my signature below, I do not agree to the use of my name, photograph, video or still asstated in the Media Release Agreement.
Applicant Full Name

First Name Last Name
Applicant Signature

Clear
Today's Date

Month Day Year
Date

Essay Questions

Limit 200 words on each essay
What is the hardest thing you have ever had to do and how did it change you?

0/200
Write an essay about some item you possess that holds great meaning for you. Describe the item and explain why it is of value to you.

0/200

Letters of Recommendation

Please enter the contact information for you two recommenders. They will both receive emails with further instructions on submitting your letters. Please note: while Recommender 1 can be any School Employee (including teachers), Recommender 2 MUST be a teacher.
Reminder: Once you submit your application, your recommenders will both be emailed with instructions on how to submit your letter. Remember to ask your recommenders before entering their names on this application. Your Recommenders will not be emailed until after your application is submitted. While the application due date is February 2nd, the deadline for Letters of Recommendation is March 1st. Your application will not be considered complete until all elements have been received, including your letters of recommendation.

You will receive an email once your recommender submits your letter of recommendation. It is your responsibility to ensure that your recommenders submit their letters in time.
Recommender 1

CCHS/CPH School Employee
Name *

First Name Last Name
Position *
Email *
Recommender 2

CCHS/CPH Teacher
Name *

First Name Last Name
Subject Taught *
Email *
Should be Empty:

Culver City Community Scholarship Application

Applicant Information

Applicant Questionnaire

Parent/Guardian Questionnaire

Media Release Agreement

Essay Questions

Letters of Recommendation