CESAR E. CHAVEZ SCHOLARSHIP APPLICATION FORM
NAME: _______________________________________________________________________________________
DOB: _____________________ PLACE OF BIRTH: _____________________________________________________
STREET ADDRESS: ______________________________________________________________________________
City: ______________________________________________________ MI___Zip Code:____________________
PHONE NUMBER: ______________________________CELL:____________________________________________
E-MAIL: ______________________________________________________________________________________
HIGH SCHOOL ATTENDING/GRADUATED: ___________________________________________________________
YEAR GRADUATED/GRADUATING: _________________________________________________________________
ANTICIPATED OVERALL GPA: ______________________________RANK IN CLASS : _________________________
COLLEGE/UNIVERSITY PLANNING TO ATTEND: _______________________________________________________
SEMESTER PLANNING TO ENROLL: _________________________________________________________________
AREA OF STUDY: ________________________________________________________________________________
EXTRACURRICULAR ACTIVITIES/LEADERSHIP ROLES: ____________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
AWARDS: ______________________________________________________________________________________
OTHER SCHOLARSHIPS RECEIVED: ___________________________________________________________________
_______________________________________________________________________________________________
PARENTS OCCUPATIONS: __________________________________________________________________________
NUMBER OF CHILDREN IN FAMILY: __________________________________________________________________
ETHNICITY: _____________________________________________________________________________________
Attach essay and all required documentation and submit as packet by deadline date. No exceptions.
I certify the statements I have made are true.
______________________________________________________________________________________________
SIGNATURE OF APPLICANT
Rev11/11
DATE
CESAR E. CHAVEZ SCHOLARSHIP APPLICATION FORM
SUBMITTAL INSTRUCTIONS
SPONSORED BY THE
SOUTHWEST MICHIGAN CESAR E. CHAVEZ SCHOLARSHIP COMMITTEE
Scholarship Information: This scholarship was established to honor a great mentor and Hispanic labor leader and
organizer. Its intent is to provide financial assistance to Hispanic students of the Southwest Michigan area in the
counties of Kalamazoo, Calhoun, Allegan and Van Buren, who have demonstrated academic success and civic
responsibility in their communities.
ELIGIBILITY CRITERIA

Must be a Southwest Michigan high school senior or high school graduate

Must be Hispanic or of Hispanic descent

Must be a U.S. Citizen or permanent resident of Michigan

Must be studying at an accredited college or university in the State of Michigan for the upcoming academic year

Must be enrolled or planning to be enrolled full-time at an accredited college or university in the State of
Michigan as an undergraduate student for the upcoming academic year

Must have earned and maintained a cumulative Grade Point Average of no less than 3.00 on a 4.0 scale

Must demonstrate financial assistance
REQUIRED DOCUMENTS

Completed scholarship application form – submitted by February 28 (postmarked)

An official transcript of grades – submitted with application by February 28

Proof of family income (copy of parents W-9 forms or filed income tax return forms) submitted with application

Proof of citizenship status (birth certificate) – submitted with application by February 28

Resume – submitted with application by February 28

Essay - Limited to 5 typewritten pages, describing why applicant believes she/he merits consideration for this
scholarship, including work experiences, school and outside activities and leadership roles, hobbies,
accomplishments, as well as any challenges or obstacles applicant has had to overcome. Include a brief
description of family background and future goals and desires. Include with application.

Letters of Recommendation - No more than 3 letters from teachers, counselors, employers, community leaders,
pastor or family friends that describe the applicant’s need, traits, character, home background, successes and
drive that would make applicant a good choice for award. Include with application.

Photo – Awardees must provide photo for the Dinner Program
APPLICATION REQUIREMENTS
The following must be submitted to the Southwest Michigan Cesar E. Chavez Committee:

One copy of the scholarship application including all the required attachments as stated herein shall be
submitted and postmarked by February 28 of each year. Applications postmarked after that date will be
disqualified.

Submit complete packet to:
AWARD AMOUNT:
Southwest Michigan Cesar E. Chavez Committee
809 N. Fletcher Avenue
Kalamazoo, MI 49006
Up to $1,000
The Cesar E. Chavez Scholarship is not renewable; however, former recipients may apply in succeeding years.
DEADLINE: February 28 of each year. Applications postmarked after that date will be disqualified.
AWARDED: March of each year at the annual Cesar E. Chavez Dinner. Awardees shall be available to attend the event.
FOR MORE INFORMATION WRITE TO:
Southwest Michigan Cesar E. Chavez Committee
809 N. Fletcher Avenue
Kalamazoo, MI 49006
Or email one of the following committee members:
Mike Ramirez, 269-387-3329 or [email protected], Cris Obreiter, 269-387-8120 or
[email protected] and Sylvia Pahl, 269-372-7937 or [email protected]
Check our webpage at: swmchavez.org
We are also on Facebook: [email protected]
Rev11/11