All applicants must either be a senior in high school with a minimum GPA of 3.2 or already enrolled in an accredited two year or four year college or university with a minimum GPA of 3.0 at the time the application is made. Plus All applicants must be able to answer, "Yes" to at least one of the following questions:

Have you been a Brisbane resident for at least 6 months prior to making this application?

Yes_____ No______

Are you a member of the Brisbane Chamber of Commerce with membership in good standing for at least the 6 months prior to making this application?

Yes_____ No______

Are you an employee of a company which employs you to work in Brisbane and which holds membership in the Brisbane Chamber of Commerce and has held such membership in good standing for at least 6 months prior to making this application?

Yes_____ No_____ Name of Company (if applicable)___________________Are you the dependent of such a Brisbane worker as described in the previous question?

Yes_____ No_____ Name of Company (if applicable)___________________

The questions above are being asked to determine basic eligibility. First you must meet the basic GPA requirements. Additionally, if you can truthfully answer in the affirmative to any of the four immediately above questions and will be a college student in the next school year, then you are eligible to make an application. If you cannot, you are not eligible and should not proceed further with this application. The questions are not weighted and no additional credit is given if you can answer more than one of them in the affirmative. Their only purpose is to determine basic eligibility. If you do not meet minimum eligibility requirements, your application won't be considered.

Value

The number and amount of awards is at the discretion of the selection committee which is made up of members of the Board of Directors of the Brisbane Chamber of Commerce. In the past, awards have been as high as $3,000, but usually have ranged between $1,000 and $2,500.

Basis of Award

In making the selection(s), the selection committee will consider such things as the following:

Scholastic Record

Participation in Extracurricular Activities

Financial Need

Acceptance into an accredited institution

DEADLINE FOR RECEIPT OF ALL MATERIALS IS MARCH 18^th, 2005

Application Procedure

1. Obtain application from the Brisbane Chamber of Commerce website on the internet (www.brisbanechamber.com) or by picking one up at the Chamber office any Monday through Thursday.

Complete the application and forward to:

attn: Scholarship Recognition Selection Committee

Scholarship Recognition Selection Committee, Brisbane Chamber of Commerce

50 Park Place, Brisbane, CA 94005

Attach or have school forward a copy of your transcript to the address as listed above.

Interviews will be conducted for all finalists either in person or telephonically.

Selection and Notification

Copies of all materials you submit will be made and distributed to the members of the Scholarship Recognition Selection Committee for review. Finalists will be contacted and scheduled for an interview. Applicants will be notified as early as possible after the process has been concluded, but in no case later than April 8, 2005. Presentation of awards will be made at the Annual Chamber Awards Dinner to be held April 27th. Award recipients and up to two people of their choice will be guests of the Chamber at this dinner. Actual payment of the award will be made once proof of enrollment and attendance are established.

APPLICATION

General Information

Name of Student_______________________________________

Date of Birth______________

Country of Citizenship____________________________

Birthplace_______________________

Home Address:

Street Address________________________

City_______________________State ______ Zip Code___________________

Phone Number: ( )

Name of school currently attending________________________________________________

If you are a high school senior or a college student transferring to another school, list the schools to which you are applying:

1.________________________2.________________________3.________________________

Major(s) or probable Major(s)_____________________________________________________

Professional Plans or Goals_______________________________________________________

Current and Prior School Information

Name of High School_________________________Principal___________________________

Have you ever been suspended or dismissed from any school? If yes, please explain below:

Cumulative GPA in High School_______ Rank in Class________

College Entrance Exam Scores:

SAT--Verbal_____ SAT--Math_____ SAT II Subjects and Scores___________ACT tests_____

List names of any colleges you have attended, dates attended, and degrees conferred, if any:

Name of School Date or dates attended Degree Awarded

Name of School Date or dates attended Degree Awarded

Name of School Date or dates attended Degree Awarded

Please attach your most recent transcript or have one sent directly by the school to:

attn: Scholarship Recognition Selection Committee

Brisbane Chamber of Commerce

50 Park Place

Brisbane, CA 94005

Note: Transcript should cover at least your last 3 academic years. If you have attended more than one school, you need to provide transcripts from more than one institution.

Activities--Instructions: In order of their importance to you, please list your major extracurricular pursuits (personal, school, religious, athletic, community, etc.) and the dates of your involvement.

Activities:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Awards--Instructions: In order of their importance to you, please list the major awards and honors (academic, work related and/or extracurricular).

Awards and Honors Received:

Please list the name or type of award or honor and the year in which it was received.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Employment Experience--Instructions: Please list your employment experiences starting with the most recent or current employment. Please use the format below, but feel free to attach additional sheets if necessary.

Employment Experience:

Name of Employer Job Title or Position Held Type of Work Dates

Name of Employer Job Title or Position Held Type of Work Dates

Name of Employer Job Title or Position Held Type of Work Dates

Name of Employer Job Title or Position Held Type of Work Dates

References*

Deadline For Receipt Of Written Recommendations Is March 18th, 2005

Instructions: Please obtain three written recommendations. At least one must be from a teacher, instructor, or professor who has taught you in an academic subject within the last two years. Remember that these are busy people who have many forms to complete and letters to write so it is courteous and best to request the written recommendation as soon as possible. Please give a stamped envelope to each person you ask to write on your behalf. Written recommendations are to be mailed to:

attn: Scholarship Recognition Selection Committee

Brisbane Chamber of Commerce

50 Park Place

Brisbane, CA 94005

Persons being asked to write recommendations on your behalf:

Name Occupation or relationship to you Telephone

Name Occupation or relationship to you Telephone

Name Occupation or relationship to you Telephone

*For previous winners of a Brisbane Chamber of Commerce Scholarship Recognition Award only one new written recommendation is required.

Financial Data

List estimated educational expenses for a full academic year:

$______________Tuition

$______________Room & Board

$______________Books and Supplies

$______________Miscellaneous School Fees

$______________Transportation Expenses

$______________Other Expenses

$______________ Total Estimated Expenses

List your sources of financial support which will enable you to pay the above expenses:

$______________Parents

$______________Insurance

$______________Student Loans

$______________Work

$______________Grants or Other Financial Aid

$______________Scholarships*

$______________Your Personal Savings

$______________Other Financial Sources

$______________ Total Estimated Resources

*Note: An award from the Brisbane Chamber will not be awarded if it is to be used to reduce the amount of a scholarship a student would otherwise receive.

Please make a statement regarding your financial situation. Can you go to college if you do not receive financial aid? How much help will you get from your parents, employment, student loans, etc.? Do you plan to work for all or part of your college expenses? If there are special circumstances in your family which cause a financial hardship, please describe. Any specific family financial information you provide will be kept confidential and only viewed by members of the Scholar Selection Committee and staff. Use additional sheets, if required.

Three Essays*

Instructions: There are limitations to what grades, scores and recommendations can tell us about any candidate. Please use the following three short essays to help us learn more about you. We hope that in writing the essays you will reflect on your attitudes, values, and your own perception of yourself. Use a separate sheet or sheets of paper for each essay topic. Limit each essay to no more than 300 words.

1. Identify a major event that influenced your life and describe in what ways it changed your behavior and/or thought processes and why it had so much influence on you.

2. What do you expect to gain from your college experience? Comment on whether there is a significant difference between a big and a small school; an urban university and a small town college; or attending a community college for awhile before seeking a four year degree? Please comment on the pros and cons of being near your home while in college?

3. The year 2005 has seen the unusual condition where two vacancies on the U.S. Supreme Court have occurred. These have resulted in much debate over the qualification of the people who were nominated to fill those vacancies. If you were a U.S. Senator what would be your role in the process of replacing a Supreme Court Justice and what criteria would you look for in the ideal nominee? Justify your answer.

*For previous winners of a Brisbane Chamber of Commerce Scholarship Recognition Award only the essay on question number 3 is required.

CERTIFICATION

I agree that, should I be selected to receive an award from the Chamber of Commerce, I will attempt to be present to receive it at the Annual Chamber Awards Dinner or I will insure that my authorized representative is present to accept it on my behalf. I acknowledge that my failure to be represented at the dinner to accept an award releases the Chamber from any obligations to me and the Chamber is free to rescind any award that was to be awarded to me at that occasion.

Additionally, should I be selected to receive a cash award from the Chamber, I will provide it with a letter informing the Scholarship Recognition Selection Committee of my status in school.

Further, I declare that any and all essays are my own work, and that all information in my application is, to the best of my knowledge, true and correct.

Applicant Signature:_____________________________ Date:____________________