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BEXAR COUNTY SCHOLARSHIP CLEARING HOUSEAn Activity ofMINNIE STEVENS PIPER FOUNDATION1250 NE Loop 410, Suite 810San Antonio, Texas 78209-1539Phone:(210) 525-8494 Fax:(210) 341-6627 Email:[email protected] APPLICATION FOR: SAZA COMMISSION, INC. – MEMBER’S MEMORIAL SCHOLARSHIPDEADLINE: 4:00 P.M. JANUARY 3, 2022This application is specific to SAZA Commission, Inc. ONLY and CANNOT be used to apply to other BCSCH ScholarshipsThe Bexar County Scholarship Clearing House (BCSCH) is a Clearing House for scholarships. This means weoffer a standardized application form and register applicants at a central location. However, if you are using thisspecific application, it can only be used to apply for the SAZA Commission, Inc.-Member’s Memorial Scholarship.The final deadline is January 3, 2022, by 4:00 p.m.Submitting this application does not guarantee a scholarship. Therefore, you are encouraged to apply for all financialaid opportunities available to you through other sources, as well as the financial aid office at the college or universityof your choice.Completing your application with attention to every detail plays an important part in your chances of being selectedas a scholarship recipient. Please note the following helpful hints: Remember deadlines: Being responsible for meeting deadlines shows you are ready for college. There willbe no exceptions to the deadline noted above. Do not leave any blanks. For example, do not skip the financial information section or forget to have yourParent sign in the Acknowledgement section (both student and parent must sign) Don’t be shy about your school and community activities. Attaching a personal résumés is encouraged. The Letter of Recommendation needs to be from an adult who is not a relative. It should reference yourcharacter in regard to truthfulness, conscientiousness, and the ability to accept responsibility. Transcripts and Exam Scores: your transcript, SAT and/or ACT scores are required with your application Personal Narratives should be limited to 200-400 words, typed. A well written autobiography can often be thedeciding factor among highly ranked candidates. Within your narrative briefly discuss one of the topics below:- Describe your future college plans, and how/why you arrived at that decision; or- Explain your choice of college and if/how a specific person, event or situation impacted your decision.NOTE: If you are chosen as an award recipient the sponsoring organization will contact you directly.BCSCH is not responsible for notifying scholarship winners.TO THE COUNSELOR To ensure accurate and timely processing of information please submit ALL documents for each student as anindividual packet secured with a paperclip (no staples, please). DO NOT copy as a 2-sided document, write on the back, or place into folders.Students may include a personal resume highlighting activities. A complete packet for each individual student will consist of the following:CHECKLIST:Application (pages 1-3)Transcript of completed coursesTranscript of pending senior year coursesTest Scores: ACT or SAT I (may be included on transcript)Evaluation from CounselorEvaluation from English TeacherEvaluation from Other TeacherPersonal Narrative (200-400 words, typed)Adult Recommendation (adult, non-relative)Advanced Placement (AP) exam scores, if applicableSignatures of both Student and Parent or Legal Guardian (on page 3)Student Name printed on all pages submitted with applicationAdditional essays, recommendations or documents as requested by scholarship organizations (if applicable)08/2021

BEXAR COUNTY SCHOLARSHIP CLEARING HOUSEAn Activity ofMINNIE STEVENS PIPER FOUNDATION1250 NE Loop 410, Suite 810San Antonio, Texas 78209-1539Phone:(210) 525-8494Fax:(210) 341-6627Email:[email protected] APPLICATION FOR SAZA COMMISSION, INC.- MEMBER’S MEMORIAL SCHOLARSHIPS T U D E N TI N F O R M A T I O NMr. /Miss Last 4 digits of SSN #FirstMiddleLastAddressNumber & StreetCityStateZip CodePrimary Phone: Alternate Phone: Email:High School you now attend: Middle School attended:AgeDate of BirthAre you a U.S. Citizen? or Permanent Resident?P A R E N TI N F O R M A T I O NFather's Name: Ageemail:Home Address Home #Number & StreetCityStateZip Code Work #Father’s Employer:Company NameCity/StateJob TitleMother's Name: Ageemail:Home address Home #Number & StreetCityStateZip Code Work #Mother’s Employer:Company NameCity/StateJob TitleIF APPLICABLE, stepfather's name and employerIF APPLICABLE, stepmother’s name and employer:Parents are: Married DivorcedIf parent(s) is(are) deceased, please check:SeparatedFatherRemarriedMotherWidowedNumber of immediate family members residing in your home (INCLUDE parents and yourself):List ages of all family members currently residing in your home:F I N A N C I A L2020 Annual gross income of family:Amount indicated should include the2020 reported income for parent(s)or legal guardian with whom you resideand any income earned yourself.I N F O R M A T I O N:1. Under 15,0002. 15,000-24,9993. 25,000-34,9994. 35,000-49,9995. 50,000-64,9996.7.8.9.10.11. 65,000- 200,000-249,999250,000 and upWho will be responsible for financing your college education?Will you be receiving Veterans Educational Benefits for college?NOTE: SOME SCHOLARSHIP DONORS MAY REQUEST VERIFICATION OF INCOME TO ESTABLISH FINANCIAL NEED.2021-1-

SAZA COMMISSION, INC.Student Name:FINANCIAL INFORMATION (cont’d)Do you have a savings account for college expenses? If so, indicate amount Indicate the number of family members in your household who will be in college (or vocational/technical school) at least half-time next year (2022-2023). INCLUDE YOURSELF!Medical/Dental expenses for 2022 not covered by insuranceExcluding general living expenses (rent, food, utilities, transportation), describe any unusualexpenses:Any comments/additional information (if there are unusual hardships in your family which may bepertinent to applying for scholarships, please briefly explain here):S C H O O LP R E F E R E N C E / I N T E N D E DM A J O RCollege or university you wish to attend:1st choiceNameCityState2nd choiceNameCityStateChoose your college major from the codes for Programs of Study, found on page 4.Intended Major(s): Code #(s) Intended Career:Explain any educational plans you may have beyond four years of college:S C H O O L&C O M M U N I T YA C T I V I T I E S(Include a personal résumé or additional pages as needed, but please do not write on back)Activities2021# ofYearsNote your role, offices held, awards received-2-

SAZA COMMISSION, INC.Student Name:E M P L O Y M E N TR E C O R DPresent Employer: Dates worked: From ToJob Title/Duties: Hours worked per week:Past Employer: Dates worked: From ToJob Title/Duties: Hours worked per week:E T H N I C I T Y/H E R I T A G EThis information is optional; however, it is used to establish your eligibility for certainscholarships that are based on ethnic/national origins.Which of the following categories best describes you?1-American Indian or Alaskan native2-Asian American or Pacific Islander3-Black or African American4-White or Caucasian5-HispanicS T U D E N T / P A R E N T(choose one or more)6-Italian American7-Puerto Rican8-Hungarian9-Other (specify )A C K N O W L E D G E M E N TWe understand that this is only a Scholarship Application and that neither Minnie Stevens PiperFoundation nor the Bexar County Scholarship Clearing House makes any representations or assurancesregarding the award or availability of scholarships.We authorize and request the Bexar County Scholarship Clearing House to release the informationcontained herein, parents' financial statements, and all other information contained in student’sApplication Packet, to possible donors and/or colleges and universities upon request of such donorsand/or colleges and universities.A FALSE STATEMENT, ALTERATION OR OMISSION OF PERTINENT INFORMATION FROM THIS APPLICATION WILL BECONSIDERED JUST CAUSE FOR REMOVAL OF APPLICATION FROM SCHOLARSHIP CONSIDERATION.Student (signature required)DateParent or legal guardian (signature required)Date2021-3-