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OSU-Cascades 2015-2016 Scholarship Application
About the scholarships...
OSU-Cascades offers scholarships from many private and public donors throughout our community. Completing this
application enables you to compete for the Chavez-Huerta Scholarship. Complete this application carefully;
follow the instructions. Award recipients will be notified by mail.
OSU-Cascades Scholarship Deadline:
Complete applications must be received by 5:00 p.m. Friday April 17, 2015
Additional information is available online: www.osucascades.edu/scholarships
FERPA Scholarship Release of Information
In accordance with the Family Educational Rights and Privacy Act of 1974 (FERPA), I, the undersigned, hereby give
my consent to Oregon State University to release education records or personal information to individuals or entities
to whom I have applied for a scholarship or who have awarded me a scholarship ("Recipients"). I consent to the
disclosure of any and all education records and personal information that is needed by Recipients to evaluate, award,
renew, update, maintain or administer my scholarship or scholarship application. These records and information
include, but are not limited to, application information (resume, letter, etc.), GPA, year in school, financial need, and
major field of study. Personal information may be re-disclosed by Recipients only as needed for their own stewardship
or grant request purposes and will otherwise remain confidential. My name, image, and directory student information
may be shared in any media release publicizing the scholarship. I understand further that:
(1) I have the right not to consent to the release of my education records and I understand that my refusal to consent
may jeopardize my eligibility for some scholarships;
(2) I have the right to receive a copy of such records upon request;
(3) This consent shall remain in effect until revoked by me.
Submission of this Scholarship Application confirms my choice to consent to, or to withhold my consent from, this
FERPA Release.
THIS INFORMATION IS RELEASED PURSUANT TO THE CONFIDENTIALITY PROVISIONS OF FERPA AND
OTHER APPROPRIATE STATE AND FEDERAL LAWS AND REGULATIONS, WHICH PROHIBIT ANY FURTHER
DISCLOSURE OF THIS INFORMATION WITHOUT THE SPECIFIC WRITTEN CONSENT OF THE PERSON TO
WHOM IT PERTAINS, OR AS OTHERWISE PERMITTED BY SUCH REGULATIONS.
I have read and agree to the above terms and conditions.
I indicate whether I consent to the FERPA information release by my choice to give, or withhold, my authorization:
I Give Consent
Signature
Print Name
I Withhold Consent
Date
Student ID Number
General Information
Last
First
Street
City
High School
Oregon resident since
Student ID Number
MI
State
City
Telephone Number
Zip
State
Date graduated or GED completion date
(date) EMAIL:
(date)
Deschutes/Jefferson/Crook County resident since
Did you attend an Oregon Community College?
No
If yes, name of Community College?
Do you have a prior college degree?
Yes If yes, what degree?
No
Are you currently receiving a COCC or OSU-Cascades scholarship?
No
Yes
If yes, which scholarship?
If employed, name of company or employer
Some scholarships are available to students with special qualifications or affiliations. Check all that apply:
Incoming freshman (less than 36 college credits)
Transfer student (36 or more college credits)
Full time student (12 or more credits per term)
Part time student (less than 12 credits per term)
Bilingual
International student
Plan to study or intern in another country
What term?
First generation college student
Documented Disability
Financial Need
While not all OSU-Cascades scholarships are dependent upon financial need, most include a financial need assessment. In order to
accurately assess student financial need, we require an official Expected Family Contribution (EFC) available at www.fafsa.gov.
If you are unable to complete the FAFSA, please explain your financial needs (any special circumstances, comments on how
you support yourself, etc):
Goals and Statement of Intent
Briefly describe your career goals as you presently see them. In 300 words or less, describe how you intend to accomplish
your goals, and how your chosen program of study will facilitate that. This is a fillable form.
1. Describe your career goals:
2. Describe how you intend to accomplish your goals and how your program of study will facilitate that:
Insight Resume
3.. Knowledge in a field/creativity: Describe any special interests and how you have developed knowledge in these areas.
Give examples of your creativity-the ability to see alternatives; take diverse perspectives; come up with many, varied, or
original ideas; or willingness to try new things. Limit Insight Resume answers to 100 words per question. This is a fillable form.
Insight Resume
4. Dealing with adversity: Describe the most significant challenge you have faced and the steps you have taken to address
this challenge. Include whether you turned to anyone in facing the challenge, the role the person played, and what you
learned about yourself. Limit Insight Resume answers to 100 words per question. This is a fillable form.
5. Handling systemic challenges: Describe your experiences facing or witnessing discrimination. Tell us how you
responded and what you learned from these experiences and how they have prepared you to contribute to the OSUCascades community. Limit Insight Resume answers to 100 words per question. This is a fillable form.
Narrative
6. Extracurricular Activities: List all activities and community services in which you have participated. Indicate positions
held (if any), hours per week devoted to each activity, and the years of participation.
7. Awards: List awards, honors, or special recognition you received during high school or college. Include community
awards or honors.
8. List paid employment positions you have held, job title, number of hours worked per week, and the years of employent.
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