DEER VALLEY SCHOLARSHIP APPLICATION - Student must be a senior with a total accumulated GPA requirement of 3.0 for 7 semesters.
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Last Name: First Name: SID# .
DEER VALLEY SCHOLARSHIP
APPLICATION
Student must be a senior with
a total accumulated GPA requirement
of 3.0 for 7 semesters.
Applications are due to the DV Main Office
on January 7th, 2022 at 3:00 p.m.
Late applications will not be accepted.
Scholarship Recipients must attend:
Scholarship Night Rehearsal on Wednesday, May 18th at 3:00 PM in the West Cafeteria.
Scholarship recipients must attend:
Scholarship Night on Monday, May 23rd at 7:00 PM.
(Students must arrive early to room 590 at 6:30 PM)
Submission Check List:
Did you:
Write legibly or type
Attach proper photo
Student sign and date application
Parent/Guardian sign and date application
Attach 1040 Federal Tax Form (if applicable)
Attach essay
Date Received:Last Name: First Name: SID# .
Deer Valley High School
Scholarship Application – Class of 2022
Deadline: January 7, 2022 - Return application to the DV Main Office
Applications will not be accepted after 3:00 p.m. on January 7th
Requirements: Total GPA minimum requirement of 3.0 after 7th Semester
Member of Deer Valley High School Class of 2022
Must attend the Scholarship Program Night, Monday, May 23 at 7:00 pm
This Application will be kept on file at Deer Valley High School for review by the DVHS
Scholarship Committee and various community scholarship committees.
Copies may be sent to Community Organizations/Donors.
Please return this application to the DV Main Office
All parts of the application must be completed.
Part I- Personal Information
Attach a current photograph of yourself (2x3 full-face, non-selfie, placed inside photo box).
Complete required information and obtain signatures.
Include a copy of your SAT and/or ACT scores if you have taken them.
Part II- Composite Sheet
Complete all information, items 1 through 16.
Part III- Essay
Submit a typed one-page statement about yourself, your future plans, and why you believe
you are qualified for this scholarship.
Attach your essay to this application.
(FORMAT: 12 pt. font; Times New Roman; Double Spaced; 1 in. Margin)
Essays not following the specified format will not be considered.
Part IV- Earnings (Optional)
Attach a copy of your parents 2020 Federal Income Tax 1040 form showing adjusted gross
income.
Please note: If earnings information is not included with the application or is incomplete, the student is
automatically excluded from consideration by the committee or donor who lists “financial need” as
all or part of their selection criteria. Student exclusion prevents their eligibility for numerous
scholarships that are offered.
In order to be considered for a scholarship, complete entire application.
Deer Valley High School Scholarship Application – 2022
Page 2 of 6PART I – PERSONAL - Print legibly or type
Last Name: _______________________ First Name:
Student ID# __________________
Address: ___________________________
City: _______________ State/Zip Code: _________ Telephone# ___________
Email: ____________________________
Age Sex: M F
Attach Photo:
Paste Photo in this
Photo Box.
(Photo of student only, ie. school/graduation picture)
In keeping with the student rights and privileges act, it is necessary
to have the following consent:
❖ I hereby give my consent to release scholarship information to those ind ividuals who
sponsor scholarships for students.
❖ I understand that all information given is subject to verification.
Date: Applicant Signature:
Parent/Guardian:
Deer Valley High School Scholarship Application – 2022
Page 3 of 6PART II – COMPOSITE
Please answer all fields to the best of your ability. Note that the information below may be
required to be considered for certain scholarships and is optional.
1.
Last Name First Name M.I.
2.
Nationality, Ethnic Background, and/or religion (list all)
3. Total number of dependents/persons in household:
4. Number of family members (including student) attending college full-time in fall 2022:
5. Career Plans
First Choice Second Choice
6. College Choice
First Choice Second Choice
7. College Major
First Choice Second Choice
8. I have taken the SAT/ACT: circle YES or NO SAT Score: __________ ACT Score:__________
9. List up to eight achievements, awards, or activities which occurred within the last 6 years, ranked in
the order of importance to you. These may include school, community or faith-related items. List the
years you received the awards and/or participated in the activities.
1. 5.
2. 6.
3. 7.
4. 8.
10. List AUSD elementary school(s) and the number of years you attended each:
11. List AUSD middle high school(s) and the number of years you attended each:
12. Are you (the student) a member of Antioch Schools Federal Credit Union for at least 6 months? _____Yes _____ No
13. I have a parent who is a member of the Antioch Schools Food Service Association. _____Yes _____
No
14. I have a family member who is a member of the Antioch Woman’s Club. _____Yes _____ No
15. My parent/guardian is a member of the Deer Valley PTSA. _____Yes _____
No
16. My parent/ guardian works in the AUSD as a classified/certificated (circle) employee _____Yes _____ No
(Location and position: _________________________________________)
Deer Valley High School Scholarship Application – 2022
Page 4 of 617. I have a family member who has served in the U.S. Armed Services. _____Yes _____ No
(Family member- state parent, grandparent, brother,etc.): ____________ / Branch served: ___________)
PART III - ESSAY
Provide a typed one-page statement about yourself, your future plans,
and why you believe you are qualified for this scholarship.
Attach your essay to this application.
(FORMAT: 12 pt font; Times New Roman; Double Spaced; 1 in. Margin)
Essays not following the specified format will not be considered.
Deer Valley High School Scholarship Application – 2022
Page 5 of 6PART IV - EARNINGS
NOTE: Completion of the financial statement is mandatory for those scholarships requiring
financial need. If financial information is not included with the application or is incomplete, the
student will automatically be excluded from consideration by the committee or donor who list
financial need as all or part of their selection criteria. Exclusion will prevent their eligibility for
certain scholarships.
___ Attach a copy of the front of your 2020 Federal Tax form in addition to completing Part II.
___ I decline to disclose my financial statement. Parent/Guardian: ________________________
(please sign)
2020 Income, Earnings and Benefits
1. The following 2020 U.S. income tax figures are from: (Please indicate with an X)
PARENT/S STUDENT
A completed 2020 Federal Income Tax 1040 form
Reminder: Attach a copy of your 2020
Federal Income Tax 1040 form
(Showing adjusted gross income)
at the end of this application.
Please note: If financial information is not included with the application or is incomplete, the student is
automatically excluded from consideration by the committee or donor who lists “financial need” as all or
part of their selection criteria. Student exclusion prevents their eligibility for certain scholarships.
• I understand that only applications that attach a financial statement
will be considered for need-based scholarships.
• I realize that my student must attend the Scholarship Awards
Night Rehearsal and Scholarship Awards Night if selected for a scholarship.
Parent/Guardian Signature: _________________________________________
Deer Valley High School Scholarship Application – 2022
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