California Institute of Technology

Most of the information requested below is used to determine your eligibility for Caltech "named" scholarships. A Caltech named scholarship is awarded from funds given to the Institute by individuals or organizations for need-based scholarships, and are named by or for the donor. Without these donors, Caltech would be unable to fund all needy students. If you are awarded a Caltech named scholarship, it will replace a portion or all of your Caltech Grant. Information from this form is also used to write letters to donors. Please provide as much information as possible about your activities, interests, employment, and research. If you are selected to receive a named scholarship, you may be asked to attend a luncheon with and/or write a note of appreciation to the donor.
All information on this form must be submitted in order to complete your Financial Aid Application. 

EXTRACURRICULAR ACTIVITIES

Do you participate in any athletic activities? Yes No
If yes, please list and specify intercollegiate (continuing) or high school (freshmen only) team, club sport, intramural competition, or personal fitness program:

Do you belong to any student associations or clubs? Yes No
If yes, please specify:

Do you participate in community service activities? Yes No
If yes, please indicate activities in which you participate on campus and in the community:

Do you hold a leadership position in any of your extracurricular activities?
Yes No
If yes, please indicate your position (title) and for which organization(s):

HONORS AND AWARDS

Please list any honors and awards you have received and from which organizations they were received:

INTERESTS / HOBBIES

Please list your interests or hobbies:

CAREER PLANS / GOALS

Are you planning to attend graduate school? Yes No
If yes, please specify intended degree and course of study:

ARTISTIC EXPRESSION

Do you have musical interests? Yes No
If yes, please specify which instrument(s) you play and any organization(s) with which you may perform:

Do you have creative writing interests? Yes No
If yes, please indicate what form of writing (e.g., poetry, prose, etc.) and any contributions you have made to publications:

Do you have artistic interests? Yes No
If yes, please indicate which medium you use (e.g., drawing, painting, photography, etc.) and any exhibitions to which you have contributed artwork:

FAMILY BACKGROUND

Are either of your parents deceased? No Yes - father deceased Yes - mother deceased Yes - both parents deceased

Do you have a parent or grandparent who is Italian and was born in Italy? Yes No
If yes, were you born in the U.S.? Yes No

Are you a direct descendant of a World War I veteran? Yes No

Are you the first member of your family to attend college? Yes No

Are you related to a graduate of Caltech? Yes No
If yes, please specify his/her name, relationship to you, and year of Caltech graduation:

Do you have a parent who works for USX? Yes No
If yes, please indicate parent's name, USX position (title), unit, and work location:

PERSONAL STATEMENTS

Why did you choose Caltech?

How has attending Caltech changed or altered your outlook? (Sophomores, Juniors, Seniors only)

Where do you see yourself in the future as a result of your Caltech experience?

What are your goals, dreams, aspirations, and hopes for the future?

RESEARCH / EMPLOYMENT HISTORY

Caltech may release my GPA to donors of scholarships and grants which may be awarded to me: Yes No

Type your full name in lieu of signature: (Required)

Your submission will be timestamped by the server.