Scholarship Application Form

Kevin Patoc Scholarship Application

Applicant*
First Middle Last
Current Age*
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
Contact Details
Primary Phone Number*
Secondary Phone Number
Email*
Primary Residence*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Letters of Recommendation
Your application requires one letter of recommendation from people who know you well. This letter should be written by someone who can describe your skills, accomplishments and personality. We value these recommendations because they reveal things about you that grades and test scores can't. Please send a request to an individual to provide this information.
Letters of Recommendations Files*
Drop files here or

Accepted file types: pdf, doc, docx, jpg.
Diagnosis Confirmation
Have you had or have cancer?*
- Yes
- No
Does an immediate family member have or has had cancer?*
- Yes
- No
If yes, who in your family has or had cancer, and what is the relation?*
Confirmation of Diagnosis
Please provide a confirmation of diagnosis letter from a medical professional and must be on letterhead from the hospital or doctor's office and must include their contact information in case we need additional information. This letter can be from an oncologist, a primary care physician, or a nurse from the care team. If you do not have immediate access to this letter, please submit without it and we will ask about it later. Please try to get it if possible.
Drop files here or

Accepted file types: pdf, jpg.
School Information
High school or school district that you lived in during high school whether public, private or home schooled?*
What year of study will you be in the fall of 2022?*
School planning to attend in the 2022/2023 school year? (1st choice if not currently enrolled in college)*
State in which the University/College is located*
Field of study/Intended major*
Career Objective*
Cumulative UNWEIGHTED GPA*
Note: Please use High School GPA, if college GPA is less than a full year.
Income Information
Did you file a tax return in 2020 or 2021?*
- Yes
- No
Did your parents file a tax return in 2020 or 2021?*
- Yes
- No
What is your parents filing status for 2021?*
College Financial Information
This section should ideally be completed after you have committed to attend a specific school. This can be either as a continuing student or by submitting your intent to register (SIR) and deposit to the school. Incoming freshman that have not received acceptances and/or submitted their SIR should provide information on their first choice school. Freshman students will be required to update this information when available.
Are you attending a new school as either an incoming freshman or transfer student?*
- Incoming Freshman
- Transfer Student
Full Name of College or University - Please Do Not Abbreviate*
(First Choice if undecided)
Total Cost of Attendance (COA):
(Published by the school - includes tuition, fees, books, room & board, etc)
Tuition and Mandatory Fees ONLY:*
Expected Family Contribution (EFC) as calculated by FAFSA application (if not filing a FAFSA, use FAFSA4caster accessible here: https://fafsa.ed.gov/FAFSA/app/f4cForm?execution=e1s1)
Parent EFC
Student EFC
Projected Financial Aid (from FAFSA or FAFSA4caster)
Pell Grant
Other Grants (CalGrant, TAP, etc):
Total amount of other grants or scholarships that are CONFIRMED for the 2021-2022 or 2022-2023 school year:
Total Number of family members in your family home*
Total Number of siblings in the household attending college in the 2022-23 school year*
Transcripts Request
Transcripts from at least TWO full calendar years and cumulative GPA on a 4.0 scale. If less than 2 years in college, please provide HS transcripts AS WELL. UNOFFICIAL transcripts ARE acceptable. Two complete years of transcripts are required. College Freshman will need to provide high school transcripts, college sophomores will need to provide high school and college transcripts, college juniors and college seniors will need to provide college transcripts.
Transcripts Files*
Drop files here or

Accepted file types: pdf, jpg.
Essays and Personal Statement
Please answer the following question (300 - 500 words) as part of your completed application.
How has cancer affected your life?
Tell us about how cancer has affected you individually or personally? (Physically, Emotionally etc.)

How has cancer affected your family? (Is/Was there a financial, psychological or other impact on your family?)

How has cancer affected you academically (Did it make academics more challenging? Did it reset your focus to a particular area of study?)

Tell us how cancer has led you to make a positive impact on the world around you?

Tell us about your community involvement.
Essay*
Drop files here or

Accepted file types: pdf, jpg.
Certification
- Yes, I certify that the above information is truthful and accurate to the best of your knowledge.
Verification
Untitled
Phone
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Kevin Patoc Scholarship Application

Contact Details

Letters of Recommendation

Diagnosis Confirmation

School Information

Income Information

College Financial Information

Projected Financial Aid (from FAFSA or FAFSA4caster)

Transcripts Request

Essays and Personal Statement

How has cancer affected your life?