Scholarship Form

Your Name

Permanent Mailing Address w/ Zip Code

Academic Level in Fall 2019

School Mailing Address w/ Zip Code

Your Email

Telephone Number

Please answer each of the following questions in 300 words or less

List activities at U.C. Berkeley including academic, social, athletic, student government, including the names of the organizations and any leadership positions held; if significant also include the same information for the year prior to matriculation to Berkeley. List activities and positions of leadership in community service organizations while at Berkeley and in the year prior to matriculating to Berkeley. (300 words or less)

Please describe how you have demonstrated leadership behavior. If possible, please include specific activities, your contribution and the outcome of those activities, e. g. , I was President of my dormitory class during which we developed a tutoring program for freshman students to assist them in preparing for their final exams, resulting in 80 % achieving a C average or better; or I was Vice President of out entrepreneurship club that was able to bring a key executive from a recent successful start-up to campus to speak.(300 words or less)

Please briefly describe why you would be the best student to return to Los Angeles after graduation and contribute to engaging alumni and supporting Haas and BHAN-LA.(300 words or less)

Please select a reference who has seen you act as a leader and can speak to your contributions. The reference may be a professor, an employer, a leader in an organization you are involved in (i.e. church leader). Instruct your reference to describe how you have demonstrated leadership and would continue to do so. Please do not use family or friends as a reference.

Reference Name

Reference Document (upload)

LinkedIn Link or Upload Resume

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