Khmer Alumni Association Scholarship Application 2016-2017

The purpose of the KAA Scholarship award is to assist local Cambodian students in the Long Beach Unified School District (LBUSD) who are pursuing higher education through an accredited community college, vocational/trade school, or university either as a part-time or full-time student.


Two students will be selected for the following:

1) $300 non-renewable scholarship
2) 2 years of private academic, career, and personal counseling provided by professionally trained and credentialed school counselors.


– Child of at least one Cambodian parent
– 2.5 minimum cumulative academic GPA
– Enrolled in the 12th grade in LBUSD
– Attending either an accredited community college, vocational/trade school, or university in the fall


Entire application must be submitted by MAY 31, 2017 and includes the following:
– Character evaluation forms (2)
– Responses to supplemental questions
– Transcript (please email 1 copy to

Last, First, Middle
Your answer
Your answer
Home Address
Your answer
City, State, Zip Code
Your answer
Phone Number
(123) 456-7890 format please
Your answer
Your answer
Academic Information
Name of High School
Cumulative GPA
(unweighted, 4.0 scale)
Your answer
Are you graduating this school year?
Are you the first in your family to pursue education after high school?
What school will you be attending next year?
If not sure, what schools are you applying to?
Your answer
What will be your major/focus of study?
Your answer
Are you enrolling part-time or full-time?
Your answer
Financial Need Information
List any extracurricular activities that you are involved in.
(volunteering, leadership, work history, clubs, etc.)
Your answer
Is there any additional information related to your financial need?
Your answer
Did you fill out a FAFSA?
Annual Household Income
Your answer
Do you qualify for free or reduced school meals?
Are you currently employed?
(If yes, please put down if you're full- or part-time with the number of hours)
Your answer
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