The Martin Luther King Jr. Scholarship Application

Print online application. Please print only - do not write.
Applicant Information (to be filled out by the student applying for the scholarship)
Name: _____________________________________________
Birth date: __________________________________________
Address: ___________________________________________
City: __________________State: _________Zip: ____________
Phone: (___ )_________________ Email: _________________
High School Name: ____________________________________
College/University currently attending (if applicable) __________________________________________________

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Please indicate your racial or ethnic origin. If multiracial, check at that apply.
___ American Indian/Alaska Native
___ Asian
___ Black or African American, non-Hispanic
___ Hispanic
___ Native Hawaiian or other Pacific Islander
___ White, non-Hispanic
___ Other

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Please list all extracurricular activities during high school/college that fall with these categories.

(You may respond on a separat sheet of paper if more space is needed)

1. Academic (e.g. honor society, math team, academic competitions, etc)
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________

2. Extracurricular (e.g. Student government, athletics, performting arts, clubs, etc.)
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________

3. Church/Ministry (e.g. leadership, service, participation, etc.)
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________
Dates of participation: From ____ to ____ Activity ______________ Position held __________________________________________

4. Please list and describe any awards or honors you have received

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5. Required Essay Response.
Write an easy (500 word minimum) in the spirit of, "I have a dream" and attach it to this application.

Taking into considerations your ethnic heritage and family traditions, and their influence on your life, share your goals and dreams for your future and how you hope to influence others as you grow and mature to your Christian faith jouney and your application of your ethnicity.

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Please return this application and essay postmarked no later than March 15, 2009 to "MLK Scholarship" Attn: Vance Pascua, 333 Sunset Blvd, Rocklin, CA 95765. The schoraship is for $1000.00 to help cover the costs to attend for your first year only. To receive award you must apply for and gain admission to a CCCU institution (visit: www.cccu.org/members_and_affiliates for a list of schools). The recipient(s) will be contact beginning April 15, 2009