1. finance
2. grants, scholarships and financial aid
3. scholarships

Futures Scholarship
2015 Scholarship Application
Cover Letter
DEADLINE: April 26, 2015 – 6pm (During Senior Weekend)
Reality Changers Headquarters - 3910 University Ave, 3rd Floor, San Diego 92105
Thank you for applying for the 2015 College Futures Foundation Scholarship! This scholarship is available
exclusively for students who have participated in Reality Changers’ College Apps Academy program.
Please complete the online application portion here: www.CollegeAppsAcademy.org/futures and then
compile your application packet to hand in to Reality Changers at Senior Weekend. Completed scholarship
application packets include the following:
1. This completed cover letter (Basic Student Info)
2. Signed Data Release form (Release of Confidential Information to Authorized Persons/Organizations)
3. Both UC Prompt Essays or Common Application Essays
4. Your academic résumé
5. Financial aid award letter from the university that you plan to attend in Fall 2015. If you are waitlisted or
appealing, please attach the second award letter with a brief explanation of your college decision
situation.
6. A copy of the front page of your family’s 2014 income tax return showing total income earned
7. An unofficial transcript
Contact Information:
NAME:
______________________________________
SSN:
______________________________________
STREET ADDRESS: ______________________________________
CITY, STATE, ZIP:
______________________________________
PHONE NUMBER:
______________________________________
HIGH SCHOOL:
______________________________________
Family Background Information:
YOUR PLACE OF BIRTH – City:_________________ State:________________ Country:________________
MOM’S PLACE OF BIRTH – City:_________________ State:________________ Country:_______________
DAD’S PLACE OF BIRTH – City:_________________ State:________________ Country:________________
YOUR ETHNICITY: ________________________________________________________________________
MOM’S HIGHEST GRADE LEVEL OF EDUCATION (example: 10th grade):____________________________
DAD’S HIGHEST GRADE LEVEL OF EDUCATION (example: 8th grade):______________________________
BONUS INFORMATION – this info will remain confidential and can add points to your application score
1. Has either parent been incarcerated? Yes / No If yes – Mom: __yrs., __mos. Dad: __yrs., __mos.
2. Have any siblings been incarcerated? Yes / No If yes – Bro(s): __yrs., __mos. Sis(s): __yrs., __mos.
3. Are you willing to take a drug test to confirm that you do not use illegal drugs? Yes / No
>>If yes, please sign up at www.CollegeAppsAcademy.org to schedule a visit at our
headquarters during Senior Weekend (April 25th 10AM-4PM or April 26th 12PM-6PM to take a
drug test)
Transmitted electronically: April 2015
Futures Scholarship
Release of Confidential Information to Authorized Persons/Organizations
By signing and submitting this form, I authorize Reality Changers to share all information held by Reality
Changers relating to me, including all information I provide in my scholarship application (including personal
information, such as my name, address and date of birth), and information relating to any scholarship awarded
to me and my attendance at any higher education institution, with the College Futures Foundation (the source
of funds for the College Futures Foundation scholarship) so that College Futures Foundation can research and
evaluate scholarships and programs, and so that it can better enable young people to attend college and
university. I further authorize College Futures Foundation to share my personal information (including my
name and birth date) with the National Student Clearinghouse in order to verify my enrollment in and
attendance at any higher education program to which I am admitted. I also authorize College Futures
Foundation to share relevant portions of my personal information with (i) governmental agencies responsible
for administering public financial aid programs, including the California Student Aid Commission, so that
College Futures Foundation can obtain information on financial aid I receive or to which I may be entitled, (ii)
any higher education institution to which I am admitted so that College Futures Foundation can verify my
enrollment and obtain information on my academic progress (including transcripts), (iii) College Futures
Foundation’s third party service providers, such as providers of College Futures Foundation’s or Reality
Changers’ data management system provider, and (iv) research institutions which undertake research on
strategies to increase access to and successful completion of higher education programs, where transcripts
and similar information are analyzed by such research institutions so that College Futures Foundation can
obtain information on my academic progress towards a degree or transfer to a four-year degree awarding
institution.
College Futures Foundation monitors the progress of students who receive scholarships funded by it so that
College Futures Foundation can better evaluate the effectiveness of these scholarships in light of its charitable
mission. I understand that College Futures Foundation will take appropriate steps designed to secure and
protect the information I provide, to keep it confidential, and to prevent others from connecting this data to me.
Except as set forth in the first paragraph of this release, any information that could identify me will be removed
or changed before such information is shared with other researchers, organizations, or institutions and before
any research results are made public in an aggregated form. Except as set forth in the first paragraph of this
release, under no circumstances will my identity be revealed by College Futures Foundation.
This authorization will remain in effect until I revoke it or modify its terms, which I may do at any time by
contacting Will Chuong (Director of Alumni Opportunities) at 619-516-2231. Further, I understand that Reality
Changers will maintain this document, that I am entitled to request and receive a copy, and that I may wish to
make a copy of this document for my own records.
Student Name: _____________________________________________
Date of Birth: __________________________
Student’s Signature: _________________________________________
Parent’s Signature: __________________________________________ (if student is under 18-years-old)
Date: _________________________________
Transmitted electronically: April 2015