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Susie Gaines-Mitchell African American Scholarship
African American Caucus
County of Sacramento    

The Sacramento County Departments of Human Assistance and Health and Human Services African American Caucus invites you to apply for their Susie Gaines-Mitchell African American Scholarship.

Susie Gaines –Mitchell’s career with the Sacramento County spanned over 3 decades.  Her accomplishments included:  First Affirmative Action Officer for Sacramento County welfare department, Member of the Black social Workers Organization, Board of Directors of Travels Aid and Sacramento Black Alcohol center, just to name a few.

Susie Gaines-Mitchell died of cancer January 18, 1995.  Our scholarship was started in 1997 in her honor.

This year we will be awarding several $500 Scholarships on May 15, 2009 at the Board of Supervisors Chambers.  Scholarship recipients will be notified by May 1, 2009.

Eligible applicants must be:
1.    A Sacramento County Resident 
2.    A graduating 2009  High School Senior
3.    Entering a two or four year accredited college/university/technical/ or trade school
4.    Must have a minimum cumulative G.P.A. of 2.5 

All documentation must be included at the time the application is received.  Please follow the check list attached.  Please note that our awards are not based on any income qualifications but are intended to be given to students who desire to advance through higher learning.

For more information, write to:
P.O. Box 161023
Sacramento, CA 95816

Student’s Name:  (Ms.)        
                             (Mr.)    __________________________________________________________________________                          
                                            Last                                                                    First                                      Middle Int.      
Address:                               __________________________________________________________________________      
                                            Street                                                                                                                     Apt.      
                                            City                                                 County                           State                 Zip Code      
Mailing Address:      
(If Different)                          ___________________________________________________________________________      
                                             Street / P.O. Box                                                                                                            Apt.      
                                             City                                                     County                                   State                   Zip Code      
E-mail Address:                   _____________________________________      
Telephone Number:             (       )____________________    Cell Phone Number:  (       )__________________________      
Date of Birth:                      __________________________    Ethnicity (optional): ________________________________      
    Are you a U.S. Citizen?       Yes       No      
    Are you a legal Resident?   Yes       No      
Parent/Guardian Name (s): ____________________________________________________________________________      
                                            Last                                                                  First                                            Middle Initial      
                                            Last                                                                  First                                            Middle Initial      
Mailing Address:                  ____________________________________________________________________________             
                                            Street/P.O. Box                                                                                                          Apt.      
                                            City                                                                              State                           Zip Code      
Telephone Number:           (        )_______________________      
High School:    _____________________________________________________________________________________      
Address:          _____________________________________________________________________________________      
                          City                                                                                                 State                            Zip Code                    
Counselor’s Name:  _________________________________________________________________________________      
Telephone Number: (        )_____________________________      
Graduation Date:     __________________________________      
Cumulative Grade Point Average (G.P.A.):  _______________      
Ö Must Include High School Transcripts with Application      
College / University / Trade School      
Currently or Planning to Addend:   ______________________________________________________________________      
Have you been accepted?               Yes       No                      Course of Study:  ______________________________      
Address:            ____________________________________________________________________________________      
                            City                                                                                                 State                            Zip Code                    
Ö  Must Include Acceptance Letter or Proof of Enrollment with Application      
Non-Relative References:      
(1)  Name:                  ________________________________________________________________________________      
  Relationship:            ________________________________________________________________________________      
  Telephone Number:  (        )_______________________________      
  How long have you known this person?    ________ Years        ________ Months      
(2)  Name:                  ________________________________________________________________________________      
  Relationship:            ________________________________________________________________________________      
  Telephone Number:  (        )_______________________________      
  How long have you known this person?    ________ Years        ________ Months      
Ö  Must Include a Letter of Recommendation from Each Non-Relative Reference with Application      
Please briefly list in order of importance your achievements and activities For Example:  School Activities / Community Involvement / Work Experience (Attach Additional Pages If Needed)      
1)  _______________________________________________________________________________________________      
2)  _______________________________________________________________________________________________      
3)  _______________________________________________________________________________________________      
Essay Questions      
Students must type their essay, title essay and indicate which essay question they are answering      
Please choose 1 of the 5 essays.  All essays must be 500 words or more:      
1)  Today's leaders recognize that our future depends on the ability to interact with people from backgrounds or cultures different from our own. What event, experience, or cultural interaction has prepared you to work and lead in a global community?
2) Why was the election of Barack Obama important to the country?
3)  Articulate the goals you have established for yourself and your efforts to accomplish these.
4). Describe any of your special interests and how you have developed knowledge in these areas?
5. Describe examples of your leadership experience and share how you have influenced others, or helped resolve
Mailing Address:  African American Caucus  Scholarship Committee      
                               PO Box 161023 – Sacramento, CA  95816      
I have read and understand the rules that apply to completing this form.  This form has been examined by me and to the best of my knowledge and belief is true, correct and complete.  I further more agree to the terms and conditions that bind this scholarship program.   Also I, _____________________________________ consent /  do not consent to having my name, photograph, image, and or quotes used for publication in newsletters, annual reports, videos, Internet web page, and presentation displays by Sacramento County’s Department of Human Assistance.  I understand that members of the general public may see my picture/image.      
Student’s Signature:       ______________________________________________  Date  _________________________      
Parent / Guardian Signature: __________________________________________  Date  _________________________      
Parent / Guardian Signature: __________________________________________  Date  _________________________      
Please Check Each Box to Validate the Accurate Completion of Your Application      
    Read the Scholarship Program rules      
      Official and sealed High School transcript (s)      
    (Copies will not be accepted)      
      Two letters of recommendation      
           (Letters from any non-relative stating your positive aspects, such as, leadership, community involvement, school activities/achievements)      
    Acceptance letter or Proof of Enrollment or Proof of Application from the college you are scheduled to attend.      
    (If chosen for a scholarship, a check will not be issued until proof of acceptance is provided)      
    Essay typed      
    Essay titled      
    Essay specifies which question was answered      
    Essay 500 words or more      
    Applicant signed application      
    Parent/Guardian (s) signed application if applicant is under 18      
    All questions on the form were answered, no answers were left blank      
    Application postmarked by April 22, 2009     



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