General Information

Name (First, Last, Middle)_____________________________________________________

Address: __________________________________________________________________

City: ________________________State: ____________Zip Code: _____________________

Telephone Number: __________________________________________________________
 

Student Identification Number: __________________________________________________

Chicano/Latino [ ] yes [ ] no   [ ] Male [ ] Female  

Marital Status [ ] Married [ ] Single [ ] Single Parent number of Dependants_______________
 

College/University Currently Enrolled for Fall 2011___________________________________
 

College/University attending in Spring of 2011 _______________________________________
 

[ ] Undergraduate [ ] Graduate Major: __________________________________________
 

Semester Hrs. Completed as of Fall 2011:______________ GPA: ____________________
 

Semester Hrs. Passed with a grade of C or better ________ 

Expected Graduation Date:________________________
 

Please attach a 1-2 page statement (typed) describing your educational and career goals, community accomplishments, and volunteer work, performance and civic organizations you may belong to. Include any personal circumstances which you feel the committee should be aware of.
 

If selected, recipients will be asked to attend the 2011 AACHE Conference where the winners will receive their scholarship.
 

One of the primary goals of AACHE is to promote the educational development of Chicanos(as)/Latinos(as) in Arizona. To achieve this goal, AACHE provides financial assistance and support to outstanding Chicana(o)/Latina(o) college and university students for their academic achievements.