DR. CARLOS MUNOZ JR.

UNDERGRADUATE SCHOLAR/ACTIVIST SCHOLARSHIP

DEPARTMENT OF ETHNIC STUDIES 506 Barrows Hall University of California Berkeley, California 94720-2570

The Department of Ethnic Studies will honor deserving undergraduate students with the Dr. Carlos Munoz, Jr. Scholar/Activist Scholarship. This award will recognize those students who have demonstrated outstanding academic achievement, leadership and activism in their community on and off campus. Scholarship applicants must meet the following criteria: Must receive financial aid Must come from an economically disadvantaged background Must have demonstrated leadership and community /campus activism in issues of peace, civil rights, human rights, immigrant rights, or social justice Must be a declared Asian American Studies, Asian American and Asian Diaspora Studies, Chicano Studies, Ethnic Studies, or Native American Studies major Must have a minimum UCB grade point average of 3.0 Must have sophomore, junior or senior standing

Students who meet the above qualifications are encouraged to complete and return the following: scholarship application, personal essay, financial aid award letter, and two letters of recommendation (see details below) to: Dr. Carlos Munoz Jr. Scholar/Activist Scholarship c/o: Dewey St. Germaine Department of Ethnic Studies 506 Barrows Hall University of California Berkeley, CA 94720-2570 Your letters of recommendation should come from someone directly familiar with your community/campus activism and a faculty member familiar with your academic performance. Student selected for the scholarship will receive an award for $500. * Previous scholarship recipients are not eligible for future awards. DEADLINE TO SUBMIT ALL DOCUMENTS IS FRIDAY, APRIL 4, 2014 ________________________

DR. CARLOS MUNOZ JR. UNDERGRADUATE SCHOLAR/ACTIVIST SCHOLARSHIP

DR. CARLOS MUNOZ JR. UNDERGRADUATE SCHOLAR/ACTIVIST SCHOLARSHIP APPLICATION
NAME:___________________________ (Last) SID #: ___________________________ __________________________ (First) SSN: _______________________ ___________________ (Middle)

ADDRESS: _________________________________________________________________ PHONE: _________________________ E-Mail: ____________________________________ MAJOR: ________________________ TERM ENTERED UCB: _______________________ UNITS COMPLETED AT UCB: ___________ OVERALL GPA: ______________ LIST SPECIFIC CAMPUS AND/OR COMMUNITY ACTIVITIES YOU HAVE PARTICIPATED IN, THE APPROXIMATE DATES OF SERVICE, AND THE CONTACT PERSON AND PHONE #:

1)___________________________________________________________________________ 2)___________________________________________________________________________ 3)___________________________________________________________________________ 4)___________________________________________________________________________ 5)___________________________________________________________________________ 6)___________________________________________________________________________ 7)___________________________________________________________________________

(SEE FINAL PAGE PRIVACY STATEMENT)

DR. CARLOS MUNOZ JR. UNDERGRADUATE SCHOLAR/ACTIVIST SCHOLARSHIP

PERSONAL ESSAY

INSTRUCTIONS: Please print or type your personal statement on a separate sheet of paper. Describe in a maximum of two (2) pages: A. B. C. D. Your involvement and contributions to campus and /or community activism. Describe your leadership role and responsibilities in the listed activities. The duration of time spent in these activities. Why you feel these activities are important.

Be sure to sign your name at the end of the essay.

PLEASE REMEMBER TO INCLUDE YOUR NAME AND STUDENT ID AT THE TOP OF EACH PAGE

DR. CARLOS MUNOZ JR. UNDERGRADUATE SCHOLAR/ACTIVIST SCHOLARSHIP

RECOMMENDATION FORM
NAME OF APPLICANT: _____________________________________________________________ The above student is applying for the Dr. Carlos Munoz Jr. Scholar/Activist Scholarship. This award honors students from the Department of Ethnic Studies who have achieved academic excellence and demonstrated leadership and outstanding activism in the area of social justice to the campus and/or communityat-large. The applicant feels that you can assist the Selection Committee in assessing his/her eligibility for this award. Please address the information requested below on a separate sheet of paper and return along with this form by Friday, April 4, 2014 to: Dr. Carlos Munoz Jr. Scholar/Activist Scholarship c/o: Dewey St. Germaine Department of Ethnic Studies 506 Barrows Hall University of California Berkeley, CA 94720-2570 1) Length of time you have known the applicant and in what capacity.

2) Applicants overall promise and strengths.

3) Applicants leadership qualities and community and/or campus activism activities.

Signature: ___________________________________ Date: ____________________________ Print Name: _________________________________ Position: __________________________ E-mail: _____________________________________ Telephone: ________________________

DR. CARLOS MUNOZ JR. UNDERGRADUATE SCHOLAR/ACTIVIST SCHOLARSHIP

RECOMMENDATION FORM
NAME OF APPLICANT: _____________________________________________________________ The above student is applying for the Dr. Carlos Munoz Jr. Scholar/Activist Scholarship. This award honors students from the Department of Ethnic Studies who have achieved academic excellence and demonstrated leadership and outstanding activism in the area of social justice to the campus and/or communityat-large. The applicant feels that you can assist the Selection Committee in assessing his/her eligibility for this award. Please address the information requested below on a separate sheet of paper and return along with this form by Friday, April 4, 2014 to: Dr. Carlos Munoz Jr. Scholar/Activist Scholarship c/o: Dewey St. Germaine Department of Ethnic Studies 506 Barrows Hall University of California Berkeley, CA 94720-2570 3) Length of time you have known the applicant and in what capacity.

4) Applicants overall promise and strengths.

3) Applicants leadership qualities and community and/or campus activism activities.

Signature: ___________________________________ Date: ____________________________ Print Name: _________________________________ Position: __________________________ E-mail: _____________________________________ Telephone: ________________________

DR. CARLOS MUNOZ JR. UNDERGRADUATE SCHOLAR/ACTIVIST SCHOLARSHIP

NOTICE TO APPLICANTS FOR FINANCIAL AID Pursuant to Section 7 of the Privacy Act of 1974, applicants for student financial aid or benefits are hereby notified that mandatory disclosure of their social security number is required by the University of California to verify the identity of each applicant. Social Security numbers are used for processing the data given in the financial aid application, in the awarding of funds, in the coordination of information with applicants for Federal, State, University, and private awards or benefits, and the collection of funds and tracing of individuals who have borrowed funds from Federal, State, University, or private loan programs. (For Committee Use Only) _______ Not Approved ______ Approved Date Approved: __________ Reasons/Comments: ___________________________________________________________________