Mariposas 2021 Scholarship Application
¡Bienvenidx! We're happy you have decided to be considered for a Mariposas scholarship. Make sure you have read the eligibility requirements for the scholarship listed on the Mariposas scholarships page. Review the information we are requesting in this form prior to entering information into the form. It might be a good idea to answer the questions in a separate document and once you finish, copying and pasting your answers into this form. This will ensure you don't lose your answers in the process. Keep in mind that Google Forms does not give you the option of returning to edit or finish at a later time.

All questions are required in order to submit. Application is due by Monday April 26th, 2021, 11:59pm.  Make sure you click “Submit Form” once you are finished! Once you press submit, you will no longer be able to add or delete information.

By submitting this application you affirm that the information contained is true and accurate.

¡Buena Suerte!

Email *
Your legal name: *
First and last name
Primary Address: *
Date of birth (MM/DD/YEAR): *
Age: *
What is your gender? *
Email: *
Phone number: *
Parent(s) or Legal Guardian name(s): *
CHCCS high school from which you will graduate: *
Current weighted GPA: *
What institution of higher education are you planning to attend in the fall : *
We want to get to know you. Tell us about yourself and your family: *
What makes you especially proud to be Latinx? *
What are some of the challenges you've had to face as a student? How were you able to overcome these? *
Tell us about 1 family member or adult role model you admire and why. What values have you learned from them? *
What line of study are you interested in pursuing? Why? *
Starting with the ones you have been more committed to, list up to 5 high school activities. For example: student government, athletic teams, clubs, organizations, etc. Include dates  and any offices held: *
Starting with the ones you have been more committed to, list volunteer service and/or community activities. Include name of the organization, responsibilities, and dates of involvement:                   *
List part-time or full-time paid employment and/or internships. Include Employer name, responsibilities, dates and average number of hours per week: *
List awards, scholarships, special programs or special recognitions you have received. You will have space to list five starting with the most recent: *
Tell us other additional personal information you feel we must know: *
Thank you for your submission! Please submit a copy of your current high school transcript and 2 letters of recommendation in sealed envelopes (one from an educator, one from a family member) to:
Barbie Garayúa Tudryn
FPGB- Mariposas Scholarship
101 Smith Level Rd.
Chapel Hill, NC
27516
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