2015-2016 Josie Torralba Romero Scholarship

Providing National Leadership for the Advancement of Latino Behavioral Health Services
2015-2016 Josie Torralba Romero Scholarship
Application Deadline: Monday, June 1, 2015 at 5pm MST
PURPOSE
The Josie Torralba Romero (JTR) Scholarship Fund seeks to honor its namesake, who was the
first President and one of the founders of the National Latino Behavioral Health Association
(NLBHA); an organization dedicated to bringing attention to the great disparities that exist in
Latino behavioral health access and utilization of services, research and behavioral health
workforce development.
Josie Torralba Romero, who passed away in 2004, had enormous dedication and love for the
Latino community. Through her work as a social worker and advocate, she worked to help
improve the country's mental health, social and child welfare systems for Latinos and other
populations. She has been praised as one of the early pioneers of social work education in San
Jose, California and as a staunch supporter and advocate for preparing culturally competent
social work students to work effectively in communities of color.
The JTR Scholarship Fund pays tribute to Josie’s legacy of "growing our own" by providing
academic scholarships to Latino students interested in pursuing undergraduate degrees in
behavioral health related academic areas in the college where the student has been admitted.
This includes the following disciplines: social work, counseling, therapy, psychology, psychiatric
nursing, or substance abuse or mental health programs.
SCHOLARSHIP AWARDS
The JTR Scholarship Fund is managed by NLBHA who awards scholarships on an annual and
competitive basis. They are awarded based upon the availability of funds and qualifying criteria
determined by the NLBHA Board of Directors. Selection criteria for all scholarships include, but
are not limited to the following: academic accomplishments, community service, leadership
potential, letters of reference and support, a personal essay and demonstrated financial need.
Scholarships are awarded for one year of academic study. Awardees shall not assume they are
eligible for renewal or additional scholarships from NLBHA although they would be eligible to
apply in subsequent years. Scholarship awardees will be encouraged to volunteer 24 hours in
NLBHA programs during the scholarship year. NLBHA pays scholarship funds directly to
students in two or three payments dependent upon whether the college or university is on a
semester or quarter basis. The second, and if applicable the third, payment is contingent on
maintaining a 3.0 (or above) GPA the previous semester or quarter. Upon receipt of grades
from the previous semester/quarter, the awardee will submit them to NLBHA to ensure the 3.0
or above GPA is maintained.
The JTR Scholarship Fund awards scholarships without regard to race, age, creed, religion,
disability, ethnicity, gender or sexual orientation, but due to the primary mission and purpose,
priority is given to Latino students.
1. DEADLINE for scholarship applications is June 1, 2015 at 5:00 p.m. MST. (NO
EXCEPTIONS)
2. Scholarship amounts are $1,000.00 for the entire 2015-2016 academic year beginning the
Fall 2015 (does not include summer sessions/semesters/quarters).
3. Incomplete applications will not be considered. Refer to application below for a list of the
supporting documents needed.
4. Award notifications will be done via email by July 1, 2015.
5. If you have any questions about the application, please call, email or text Fred Sandoval,
MPA, at [email protected] or by calling 505-980-5156. You can also download the
application at www.nlbha.org, click on JTR Scholarship Fund.
ELIGIBILITY CRITERIA
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Applicant must have residence in the state of New Mexico.
Non-citizen students enrolled in high school or college are eligible to apply.
Applicant must be accepted as a full time (12 credit hours or more) student at a college
or university program during the 2015 academic year.
Scholarship are awarded to students attending the same college or university for the
entire academic year.
Applicants must demonstrate financial need for scholarship assistance.
By submitting this application, applicant understands the voluntary 24 hours of service
with NLBHA if they are awarded a scholarship.
Student must have applied for the 2015-2016 school Federal Student Aid Application
(FAFSA).
Student must submit a copy of their 2015-2016 school year Student Aid Report (SAR).
TIMELINE
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Complete scholarship applications are due Monday June 1, 2015 by 5:00 pm MST and
emailed to the attention of Fredrick Sandoval, MPA, Operations Manager at
[email protected] Send with return receipt. An email reply will be sent to applicants to
verify that the application was received.
Award notifications will be sent by email by July 1, 2015.
Scholarship recipients will receive their scholarship awards only after their grades from
the previous semester have been received by NLBHA.
Contact Fred Sandoval at [email protected] for more information.
APPLICATION SUBMITTALS
ALL SCHOLARSHIP APPLICANTS MUST PROVIDE:
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A completed and signed JTR Scholarship application.
Proof of residence in the State of New Mexico.
Official high school or college transcript in a sealed envelope from the institution.
Two academic letters of references (e.g., from a guidance counselor, teacher, school
administrator or professor).
A letter of support from an employer or other community member.
Proof of acceptance/enrollment at an academic, community college or university for the
academic year the applicant is applying for.
Demonstrated financial need.
SERVICE (VOLUNTEER) CRITERIA FOR SCHOLARSHIP RECIPIENTS
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If applicant is awarded a scholarship, NLBHA encourages awardees to volunteer 24
hours during the academic year with NLBHA. Volunteer hours are counted beginning
the start of the 2015 academic year through the end of spring, 2016 academic year.
All scholarship recipients will coordinate a plan for how they will meet their NLBHA
service requirement with the NLBHA Operations Manager after accepting the
scholarship and before beginning their college/university studies.
Providing National Leadership for the Advancement of Latino Behavioral Health Services
2015-2016 Josie Torralba Romero (JTR) Scholarship Application
Application must be typed and filled out by the applicant. Type N/A if a question does not apply to you.
Please type your answers below.
1.
Last Name:
2.
Mailing Address
First Name:
Street:
City:
State:
Zipcode:
3.
Daytime Phone Number:
Email:
4.
Current High School or
College/University:
Anticipated High School or
College/University Graduation Date:
5.
I Will be Attending the Following College/University:
Begin Date:
College/University Address:
College/University Phone:
6.
College/University Website:
What Year Will You Enter School:
Freshman
7.
Will You be a Full-Time Student?
Yes
8.
Will You be Living on Campus?
9.
Current Grade Point Average (GPA):
Yes
Sophomore
No
Junior
Senior
(Specify # of Credit Hours:
No
If No, Will You be Commuting?
Yes
(On a 4.0 scale)
As proof of GPA, submit your most recent official high school or college/university transcript.
10. For Entering Freshmen (A copy of your ACT or SAT score sheet is required.)
ACT Score:
or SAT Score:
11. Name & Address of Parent(s) or Legal Guardian(s):
Name:
Street:
City:
Phone Number:
State:
Zipcode:
No
Providing National Leadership for the Advancement of Latino Behavioral Health Services
Please type your answers below.
12. List the Name of Any College/University You Have Attended
Year
Began
a.
b.
c.
13. What is Your Planned Specialty/Major as You Continue Your Education?
14. List Expenses You Expect to Incur per Semester or Quarter (Approximate Figures Acceptable).
Make Additional Comments if Needed
a. Tuition:
b. Books:
c. Room & Board:
d. Other Expenses:
e. Other Expenses:
Year
Ended
Year
Graduated
Type of
Degree Received
Providing National Leadership for the Advancement of Latino Behavioral Health Services
Please type your answers below.
15. List Other Financial Assistance You WIll Receive per Semester or Quarter:
a. Personal:
Amount: $
b. Other Scholarship(s):
Amount: $
c. Grants:
Amount: $
d. Student Loan(s):
Amount: $
e. Other Financial Resources:
Amount: $
16. School Extra-Curricular Activities: Please list school extra-curricular activities in which you have participated. Note leadership roles and dates.
17. Area of Behavioral Health Study: Why are you studying this field of study? Explain why you believe it is important to address Latino behavioral health.
(200 words or less)
18. Organizations: Please list community organizations such as service, volunteer and religious organizations in which you are now active or have previously been active.
Note leadership roles and dates.
19. Recognitions: Please list awards and recognitions received. Note organizations presenting honor, reason for award, and date.
Providing National Leadership for the Advancement of Latino Behavioral Health Services
Please type your answers below.
20. Goals: What are your personal short and long term goals? (200 words or less)
21. Need: Please explain your financial need for the Josie Torralba Romero Scholarship. (200 words or less)
22. Career Plans: What are your career plans and what would you like to be doing in 10 years? (300 words).
23.
Checklist
The following items must be attached to this application in order for the application to be deemed complete.
Your application will not be reviewed if these items are not attached to this application. (No exceptions.)
Circle or check “YES” or “NO” to be sure you have attached each item as required.
Yes
No
Two academic letters of reference and one community letter of reference.
Attach your references to the application form.
Yes
No
Proof of college/university acceptance or current student enrollment.
A letter of college/university acceptance is required for receipt of funds.
Yes
No
Most recent official high school (for freshman applicants) or official college/university transcript (for all
others). Photocopies of your transcript are not acceptable.
Yes
No
Proof of permanent residence in the State of New Mexico.
Yes
No
Copy of Student Aid Report.
Yes
No
Answers to questions 1-21
Yes
No
300 Word Career Plan Essay
Providing National Leadership for the Advancement of Latino Behavioral Health Services
Statement of Accuracy
I hereby affirm that all the above stated information provided by me to The Josie Torralba Romero Scholarship Fund Committee is true, correct and
without forgery. I also consent to submit a photograph to be posted on the NLBHA website and for such purposes deemed necessary to promote
the Josie Torralba Romero Scholarship Fund Scholarship Program if I am awarded.
I hereby understand that if chosen as a scholarship awardee, according to the Josie Torralba Romero Scholarship Fund scholarship policy, I must
provide evidence of enrollment/registration at the post-secondary institution of my choice before scholarship funds are awarded.
I hereby agree to participate in the Scholarship Luncheon honoring JTR Scholarship awardees and the JTR Scholarship Benefit Concert event in
September 2015.
Signature of scholarship applicant: __________________________________________________Date:_____________
Witness:__________________________________________________________________Date:_____________
The deadline for receipt of this application by
NLBHA is Monday June 1, 2015 by 5:00 p.m. MST. No exceptions!
Contact Us: Please contact Fredrick Sandoval, MPA, Operations Manager at [email protected], by cell or text @ 505-980-5156
or by going to the Contact Us page on http://www.nlbha.org if you have any questions.
Spanish speaking or Limited English Proficient students can communicate in their language of preference.
Si necesitas ayuda con la aplicación en Español, puedes llamar a 505-980-5156
y pregunta por Fred Sandoval o puedes mandar mensaje electronica a [email protected]