RMHC/HISPANIC AMERICAN COMMITMENT TO EDUCATIONAL RESOURCES

SAN DIEGO SCHOLARSHIP APPLICATION 2016 MAKING A LONG-STANDING COMMITMENT TO EDUCATION AND INVESTING IN FUTURE LEADERS Ronald McDonald House Charities® (RMHC) of Southern California, RMHC of San Diego, the McDonald’s Operators’ Association of Southern California (MOASC) and the McDonald’s Operators’ Association of San Diego (MOASD) offer scholarships to local students as part of McDonald’s ongoing commitment to education.

APPLICATION DEADLINE: MARCH 18, 2016

With education costs spiraling ever higher, a college education is beyond the financial reach of many outstanding students. A partnership between RMHC and its local restaurant owner/operators opens the door to higher education for graduating high school seniors who face limited access to educational and career opportunities. The RMHC scholarship program seeks to invest in students who are exemplary role models in their communities and have the initiative to fulfill their educational goals. ELIGIBILITY Applicants must be currently enrolled high school seniors in San Diego County who have at least one parent of Latino/Hispanic heritage, and who are eligible to enroll and attend an institution of higher education or vocational/technical school with a complete course of study in the year immediately following graduation. Students must reside within San Diego County. Applicants must be legal U.S. residents, be less than 21 years of age and have a minimum average 2.7 GPA (unweighted) for grades 9 to 12. Applicant must disclose other scholarship programs for which he/she has applied. Applicant must be willing to provide additional verification of all information in the scholarship application upon request. APPLICATION REQUIREMENTS • Eligible students must submit a complete application and attach all of the required documentation or their application will not be reviewed. • Applications and supporting documents must be enclosed in a single envelope and be postmarked no later than March 18, 2016. SCHOLARSHIP TERMS & CONDITIONS The San Diego RMHC/HACER Scholarship Program will award 15 one-year scholarships worth $2,000 each to graduating high school seniors in San Diego County. Recipients will be selected by an advisory board consisting of educators, and community and civic leaders. Scholarship recipients must enroll in and attend full-time a two- or four year accredited college or university or vocational/technical school in the academic year following their selection. Verification of full-time enrollment is required. Scholarship funds apply for the 2016-2017 academic year,

and will be paid by check directly to the accredited institution in which the student enrolls, not directly, nor reimbursed to an award recipient. Funds must be dispersed by June 30, 2017. Scholarship awards may be applied toward tuition, fees, room and board and/or other approved expenses incurred directly with the college/university. SUPPORTING DOCUMENTS Transcript, Personal Statement, Letter of Recommendation, and Proof of Financial Need are REQUIRED. • A certified high school transcript that contains the student’s class rank and test scores must be submitted with the attached application. Applicants must carry a minimum average 2.7 GPA (unweighted) for grades 9 to 12. • Applicants must submit a personal statement that provides information about their Hispanic background, career goals and desire to contribute to their community. Information about unique, personal or financial circumstances may be added. The statement should be double-spaced, no smaller than 12-point font and no more than two pages in length. • A one-page letter of recommendation from one of the applicant’s teachers or a school official or mentor of volunteer or experience or work is required. The letter should detail the applicant’s background, achievements, leadership abilities and community involvement. Letters should contain personalized information about the applicant. Generic letters will be given minimum consideration. • Applicants must submit a current (2014 or 2015) copy of the IRS Form W2 or 1040 Income Tax Return Form filed by his or her parent(s) or guardian(s), or other documentation demonstrating proof of financial need. CERTIFICATION & RELEASE All applicants and, where appropriate, their parent or guardian, must sign the attached application, certifying that all information provided is true and complete to the best of their knowledge. If later determined that information contained in application is false or misleading, final awards may be rescinded. Upon submission of the completed application, applicants grant RMHC and McDonald’s the right to use any information contained in the application for the purpose of promoting and publicizing the Program, or as legally required or permitted by law. SUBMISSION OF THE APPLICATION All complete applications must be postmarked by March 18, 2016. Incomplete applications will not be considered. Applications must be sent to: RMHC/HACER Scholarship Program c/o Nuffer, Smith, Tucker 4045 Third Ave., Suite 200 San Diego, CA 92103

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BACKGROUND Ronald McDonald House Charities (RMHC), a nonprofit, 501(c)(3) organization, creates, finds and supports programs that directly improve the health and well being of children. Its programs are grassroots-driven to enable the charity to offer help where children need it most—right in their own communities. Driven by a passion to reach out to children in need and help them reach their full potential, RMHC works to break down barriers, build bridges and find solutions to the most urgent problems facing children and families today.

SAN DIEGO RMHC/HACER SCHOLARSHIP PROGRAM 2016 APPLICATION APPLICANT: To the best of your knowledge, please record your information in the boxes below.

Class Rank

No. in Class

SAT Critical Reading

ACT Composite

SAT Math

High School Unweighted GPA (Grades 9-12)

SAT Written

High School Weighted GPA (Grades 9-12)

Mail the application by March 18, 2016 to: RMHC/HACER Scholarship Program, c/o Nuffer, Smith, Tucker 4045 Third Ave., Suite 200, San Diego, CA 92103

APPLICANT GENERAL INFORMATION (Please print or type) Male

Female

_____________________________________________________________________________________________ First

MI

Last

Permanent Mailing Address ______________________________________________________________________ No.

Street

Apt. #

_____________________________________________________________________________________________ City

State

Zip

Home phone number

_____________________________________________________________________________________________ E-Mail Address

Alternate phone number

Ethnicity/Nationality (optional) ____________________________________________________________________ Are you a legal U.S. resident?

Yes

No

Are you a high school senior?

Yes

No

Are you or an immediate family member a McDonald’s employee?

Yes

No

Applicant, please provide all of the information requested in the boxes below. This information helps establish your eligibility for scholarships granted under the Program. If we do not have this information, you may not be considered for a scholarship. Country: United States of America State:

County in which your current city of residence is located:

PARENT/ GUARDIAN FINANCIAL DATA 1.

Adjusted gross income.

2.

Yearly untaxed income and benefits. Please indicate source: Social Security AFDC Child Support Other ________________________________________________

3.

Total number in the household and primarily supported by the reported income.

4.

Total number of family members attending college at least half-time during the next school year, including applicant.

5.

Marital status of parent or guardian. Married Divorced Separated Widowed Single

6.

Estimated annual college costs (tuition, room and board, etc.)

$ (Please attach IRS Form 1040, W2, or other documentation)

$

FAMILY INFORMATION Applicant’s Place of Birth: (City, State, Country) ___________________________________________________ Date of Birth: _____________________________________________________________________________ Parent/Guardian: ____________________________________________________________________________ First Last Relationship Parent/Guardian: ____________________________________________________________________________ First Last Relationship Alternate Phone Number/Contact Name: _________________________________________________________

APPLICANT’S ACADEMIC STATUS AND HIGH SCHOOL INFORMATION High School: _________________________________________________________________________________ Address: ____________________________________________________________________________________ City: _________________________________ State: ___________________ Zip: _______________________ High School Counselor’s Name: _________________________________________________________________ High School Counselor’s Office Telephone Number: __________________________________________________ High School Counselor’s E-mail Address: __________________________________________________________ Name of College or University You Have Applied to Attend: ____________________________________________ Intended Major: ______________________________________________________________________________

How did you hear about the program? Guidance Counselor

Website

Scholarship Directory

Other _____________________________

Please check the box if you are a first generation student to attend college.

C O M M U N ITY IN V O LV EM EN T SCHOOL /EXTRACURRICULAR ACTIVITIES. List up to five activities in which you have had the most involvement in the last four years (school clubs, student government, publications, varsity or club sports, theater arts, Scouting, 4H, etc.). Also list years involved and highest position held. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ COMMUNITY/VOLUNTEER SERVICE. List up to three agencies or organizations in which you have participated WITHOUT PAY during the last three years (religious groups, hospital volunteer, cultural activities, outreach programs, etc.). Enter TOTAL hours per activity, over the last three years. Do not use acronyms. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ WORK EXPERIENCE. List the last three jobs you have held the longest (food server, babysitting, lawn mowing, office work, etc.).Also include dates of employment and average number of hours per week. Do not use acronyms. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

O TH ER SC H O LA R SH IPS PLEASE LIST OTHER SCHOLARSHIP PROGRAMS FOR WHICH YOU HAVE APPLIED: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

CERTIFICATION AND AUTHORIZATION All of the information that I have provided in this application and in the enclosed letters is true and complete, to the best of my knowledge. I understand and acknowledge that providing false or misleading information in any aspect of this application or any enclosed letters may lead to the rescinding of any award that I may have received. I authorize Ronald McDonald House Charities and/or McDonald’s to verify any of the information contained herein – including after the awarding of the scholarship. I certify that I am currently enrolled and in good academic standing as a senior in high school, enrolled in or applying for full-time enrollment to a two- or four year accredited college, university or vocational/technical school for the 2016-2017 academic year and am eligible to receive scholarships granted under the Program. I understand that should I be selected for a scholarship, I (or my parent/guardian on my behalf) will be required to execute a talent release form prior to the award of any scholarship. I may also be required to provide a photo for publicity purposes or participate in media events at selected times to promote the Program and agree that my attendance or participation in such requests (unless excused for cause) may lead to revocation of any award. I hereby authorize RMHC®, RMHC of Southern California, RMHC of San Diego, McDonald’s®, MOASD and MOASC to use any information contained in this application and my likeness for the purpose of promoting and publicizing the RMHC/HACER Program, or as legally required or permitted by law. Authorization for release of records To comply with the provisions of the Family Educational Rights and Privacy Act of 1974, permission is hereby given to applicant’s school officials to release the applicant’s secondary school record and other requested information for consideration in the program

Applicant Signature: (required) __________________________________ Date: _____________________ Parent or Guardian’s Signature: _________________________________ Date: _____________________ (Required if applicant is under 18 years of age)

Please attach your personal statement in a separate document. Be sure to include your name and address on the top, right hand side of your personal statement. Confirm that your transcripts, letter of recommendation and financial documents are attached, or your application will not be reviewed. Do not staple.