Date: _____________ Indicate whether application is for: Scholarship ________ Fellowship _________ (If both, indicate first choice) Please use additional pages as needed. 1. Name: __________________________________________________________ 2. Current Address: __________________________________________________ ________________________________________________________________ ________________________________________________________________ 3. Telephone Number: ________________________________________________ 4. Law School: ______________________________________________________ Current year and units completed _____________________________________ Day or night: ______________________________________________________ 5. Marital Status: ____________________________________________________ 6. Dependents (include ages and relationship): _____________________________ ________________________________________________________________ ________________________________________________________________ 7. Date and Place of Birth: _____________________________________________ ________________________________________________________________ 8. Academic Background (other than law school): School/ Degree/Date Academic Honors, Awards University Conferred & Commendations Received ___________________ ___________________ ________________________ ___________________ ___________________ _______________________ ___________________ ___________________ ________________________ ___________________ ___________________ ________________________ 9. Law School GPA: __________________________________________________ 10. List all academic honors and awards received and professional memberships while in law school. 11. List all scholarships and grants received in law school, by amount received and year of receipt. 12. List all school loans (including undergraduate loans). Lender Amount Borrowed Amount Repaid Date __________________ __________________ _______________________ __________________ __________________ _______________________ __________________ __________________ _______________________ 13. Describe your income sources. 14. State the amount contributed by parents or other relatives. 15. State amount provided by other source(s) and describe the source(s). 16. State the amount you have contributed and describe the source(s). 17. Please provide any other information which is relevant to your financial need. 18. State the reasons you decided to go to law school. 19. Describe your past and present community activities. 20. What do you feel are the most pressing problems facing the Asian American and Pacific Islander community today? 21. Provide a statement of your present and future goals with regard to how you can contribute to the Asian American and Pacific Islander community. 22. Indicate why you are interested in the Scholarship or Fellowship, or both. If you are are applying for the Fellowship, you must confirm your availability and commitment to clerk at the Asian Pacific American Legal Center for 12 weeks during Spring or Summer 2000 at a minimum of 8 to 10 hours per week. If you are applying for the Scholarship, you must confirm your willingness to serve as the PABA law school liaison and attend monthly PABA board meetings. 23. Provide any other information that you feel is relevant to your application. (Use additional pages as needed.) All information furnish to PABA as part of your Scholarship/Fellowship Application will remain strictly confidential. I certify that the information in this Scholarship/Fellowship Application is true and correct. Any material misstatement or omission will disqualify me for consideration and an award. __________________________ _________________________________________ Date Signature