Scholarship Application

1. Full Legal Name: *

2. Gender: *

3. Social Security Number: *

4a. Date of Birth: Ex. 06/09/1986 *

4b. Age:

5. Telephone Number: *

6. E-mail Address: *

7a. Preferred Mailing Address: *

7b. City: State: Zip code: *

8. Residency and Country of Citizenship: *

9. Race/Ethnicity: *

10. Primary Language: *

11A. Name of High School/GED completion *

11B. High School/GED Completion Date * *

11C. Name of first College/University Attended *

11D. First Collge/Univeristies Address, City, and State *

11E. List all other Collge/Univeristies Attended, City, and State:

11F. Last Date attended College/University: *

11G. Name & Address of University Re-admitted to: *

11H. University readmittance Date: *

11I. Did you receive a re-admit letter from the university? *

Yes No

11J. Current Cumulative GPA from University re-admitted: *

11K. Expected Graduation Date *

12. What is your current tax status -Dependent/Independent Status: *

13A. Gross Annual Income in 2007: $$ *

13B. Family Size in 2007: *

13C. Did you file federal income tax in 2007 or thereafter? *

Yes No

13D. Do you or anyone in your household receive child support or alimony? *

Yes No

13E. What is the total gross monthly Child Support and Alimony contributions? *

13F. Is your child support and/or alimony court ordered? Indicate an answer. *

Yes No

14A. Are you married? *

Yes No

14B. What is your Spouse's Gross Annual Income in 2007: $$

15A. Have you received any Honors and Awards: *

Yes No

15B. List Honors and Awards include year received:

16A. Do you participate in Unpaid volunteer work and community service? * *

Yes No

16B. List Name of Unpaid Volunteer Work and Community Service, include: City, State and Year:

17A. Paid Employment: *

Yes No

17B. List Paid Employment, year employed, and provide telephone number with area code (for the past 5 years): *

18A. Have you particpated in Leadership Roles: *

Yes No

18B. List Leadership Roles and year:

19. List three academic subjects in which you excel or have excelled. *

20. List the subjects with which you had difficulties. *

21. Briefly describe a situation in which you felt that you or others were treated unfairly or were not given an opportunity you felt that you deserved. *

22. Briefly discuss your short term career goals for the five years: *

23. Briefly discuss your long term career goals in 10 years: *

24. Briefly discuss your involvement in and contributions to a community near your home, school, or elsewhere: *

25. Briefly discuss other than from school, in areas (non-academic or academic) have you acquired knowledge or skills? *

26. Is there anything NEW you would like to tell us about personal characteristics, obstacles you have overcome, etc. that may help us evaluate your nomination? *

27. Authorization: You agree to give our staff your authorization to release your name to organizations seeking interns, as well as permit the administrator of the JHF program or administrative approved organizations to consider your nomination for other scholarship programs. Please understand that you are still responsible for applying to all scholarship programs for which you are interested. *

Yes No

28. Did you complete a current FAFSA? *

True False

If you are submitting this application online, you understand that you must be 18years or older. In addition, sign below by typing in the space provided for your signature, your full legal name indicating your execution can be adopt with the intent to sign the application. We do not accept Nominee applications online. Do not mail in a hard copy. The Nominee Application and Information Form must be returned to JHF by the deadline. We do not accept paper applications via mail. All online applications must be submitted by December 1, 2009 11:59 p.m. PST.