Mi Pueblo Food Center is honored to support the dreams of hardworking, highly motivated graduating high school seniors in the

communities we serve. Together, thanks to the support of our kind and generous customers, employees, vendors and friends, we will be awarding college scholarships to many deserving students who are working very hard to make their dreams come true. We invite the students who meet our eligibility requirements to follow these instructions carefully and submit their application.

2011 2012 SCHOLARSHIP GUIDELINES

ELIGIBILITY REQUIREMENTS Scholarship applicant must: Be a graduating high school senior. Be residents of one of the following counties: Alameda Contra Costa Marin Merced Monterey Santa Clara Santa Cruz San Mateo Stanislaus Solano Demonstrate strong educational motivation and commitment to compete on a collegiate level. Have earned a minimum 3.00 cumulative grade point average. Demonstrate community service efforts. Demonstrate financial need.

APPLICATION CHECK LIST Applicants must submit the following documents in one complete package: Completed application (PARTS I, II, III, and IV). 3 essays as described on page 5, part IV. Official high school transcript. If you have taken any college courses, include transcripts of your work. Two letters of recommendation as described on pages 6 and 7. Completed application must be mailed to P.O. Box 3288, San Jose, CA 95156 postmarked by May 13th, 2011.

AWARDS Scholarship winners will be notified by e-mail, mail, and/or by phone by approximately June 10th, 2011. The amount of each scholarship award will vary based on academic achievement and will be between $500 $2,500. Scholarship winners must attend the Mi Pueblo Scholarship Award Ceremony, which will take place approximately on June 25th, 2011. If awarded a scholarship, the student must enroll as a full-time student at a 2-year or 4-year institution. Proof of enrollment is required to release the awarded scholarship funds to the institution.

PLEASE NOTE: INCOMPLETE APPLICATIONS WILL BE AUTOMATICALLY DISQUALIFIED

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2011 2012 SCHOLARSHIP APPLICATION

PLEASE PRINT CLEARLY PART I: PERSONAL INFORMATION Last Name Gender First Name Ethnicity Middle Name Birth Date Age

M F Citizenship (select one) The following is for statistical purposes only U. S. Citizen Legal Permanent Resident AB 540 Student

(PLEASE NOTE THAT YOUR CITIZENSHIP STATUS WILL NOT AFFECT YOUR ELIGIBILITY) Address City Home Phone Number ( ) E-mail (Print Clearly) High School Name High School Address City State CA Cell Phone Number ( ) Zip Code County

Current Grade Level State Zip Code

List of Colleges and/or Universities you have applied for:

Which college or university do you plan to attend in the Fall of 2011? What are your educational goals, and why?

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2011 2012 SCHOLARSHIP APPLICATION

PLEASE PRINT CLEARLY PART II: COMMUNITY SERVICE & EXTRACURRICULAR ACTIVITIES (Include paid work) Name of Organization Type of Service / Activity Position(s) Held Starting Ending Hours Date Date per Week

1.

2.

3.

4.

5.

6.

Attach a separate piece of paper if you need more space. CERTIFICATION: I hereby certify that the information about my community service is true and complete to the best of my knowledge. __________________________________ Applicants Printed Name ______________________________________ Applicants Signature

____________________ Date
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2011 2012 SCHOLARSHIP APPLICATION

PLEASE PRINT CLEARLY PART III: DEMOGRAPHIC INFORMATION Applicants demographic information is collected for the sole purpose of this scholarship application, and it is maintained confidential. Any information included in this section will not affect eligibility for the scholarship. Name of Father Occupation Highest Level of Education

Name of Mother

Occupation

Highest Level of Education

Parents marital status Married What is your annual household income? < $15,000 Divorced Other____________

$15,001 $30,000

$30,001 $45,000 > $75,000

$45,001 - $60,000 $60,001 - $75,000 How may dependents are in your household?

What is the primary language spoken in your home?

Are you a first generation college student?

Yes

No

CERTIFICATION: I hereby certify that the information about my demographics is true and complete to the best of my knowledge. __________________________________ Applicants Printed Name ______________________________________ Applicants Signature

____________________ Date
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2011 2012 SCHOLARSHIP APPLICATION

PART IV: ESSAY QUESTIONS On separate pieces of paper, please include the following essays: Essay 1 Describe your involvement in extracurricular activities, including community service. If you have served as a leader in any of these activities, tell us about an accomplishment that you are most proud of.

Essay 2 Tell us about yourself and the experiences and challenges you have faced that have shaped you into the person you are today.

Essay 3 What do you know about Mi Pueblo stores? What do you think are our best attributes and ways that we can continue to improve as a company? All three (3) essays are required. Essays must be typed written in a 12 font size. Type your first and last name on each page (last name first). Each essay should consist of a minimum of 300 to a maximum of 500 words.

IMPORTANT: Application materials must be postmarked no later than Friday, May 13th, 2011. Please send your completed application to P.O. Box 3288, San Jose, CA 95156.
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Mi Pueblo Scholarship Letter of Recommendation #1 (To be completed by applicants educational instructor or counselor)

Student Name: ______________________________________________________________________ Last First

Phone Number: ______________________________ E-mail:__________________________________ Top section is to be filled out by the student.

Name of School: _____________________________________________________________________

School Address: _____________________________________________________________________

Your Name & Title: ___________________________________________________________________ Length of Time you have known the student: _______________________________________________

Phone Number: ______________________________ E-mail:__________________________________

Signature: ____________________________________ Date: _____________________

Please tell us about this student and why he/she deserves to be awarded a Mi Pueblo Scholarship. You may refer to the following areas: Scholastic achievement Community involvement Leadership skills Extraordinary qualities Special circumstances

Please include students first and last name on each page (last name first). Seal your letter of recommendation and give to the student for submission.
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Mi Pueblo Scholarship Letter of Recommendation # 2 (To be completed by applicants educational instructor or counselor, or a community leader)

Student Name: ______________________________________________________________________ Last First

Phone Number: ______________________________ E-mail:__________________________________ Top section is to be filled out by the student.

Name of School: _____________________________________________________________________

School Address: _____________________________________________________________________

Your Name & Title: ___________________________________________________________________ Length of Time you have known the student: _______________________________________________

Phone Number: ______________________________ E-mail:__________________________________

Signature: ____________________________________ Date: _____________________

Please tell us about this student and why he/she deserves to be awarded a Mi Pueblo Scholarship. You may refer to the following areas: Scholastic achievement Community involvement Leadership skills Extraordinary qualities Special circumstances

Please include students first and last name on each page (last name first). Seal your letter of recommendation and give to the student for submission.
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2011 2012 SCHOLARSHIP APPLICATION

SCHOLARSHIP RULES Students awarded a Mi Pueblo Food Center scholarship must comply with the following rules. Scholarship is awarded for the Fall 2011. The awards will be given to the students selected institution and it will be mailed out to the institutions financial aid office within 30 days of receipt of proof of students full-time enrollment. If a student is awarded a scholarship, but is unable to begin college in the Fall 2011 for any reason, the student must notify us at scholarships@mipueblofoods.com before September 30th, 2011 to request an extension. Extensions can provide students up to one calendar year to claim the scholarship. Unclaimed scholarships will be reallocated to other scholarship award recipients. Scholarship winners must attend the Mi Pueblo Scholarship Award Ceremony, which will take place on approximately June 25th, 2011. Student must sign the following media release.

I hereby consent that all photographs, motion picture (film and video), and/or recordings made of my likeness and voice in whole or in part, are proprietary of Mi Pueblo Food Center, Inc., as stated in the paragraph below: I do agree to consent with no limitation on time and extension, the use or publication of my likeness and voice on all and any broadcast media, printed illustration, internet site and or any other media for advertising and promotional purposes of Mi Pueblo Food Center, Inc. I hereby release and discharge Mi Pueblo Food Center, Inc, and all the parties involved in the making of these programs from any and all liability arising out of any injury of any kind that may be sustained by me from participation in or in connection with the making or utilization of any of the rights granted hereunder. Inc. and affiliates. _____________________________________ Name of Student _______________________________________ Student Signature ___________________________ Date

__________________________________________________________ Parent or Legal Guardian Signature (if student is under 18 years of age)

Print and mail your completed application to P.O. Box 3288, San Jose, CA 95156 postmarked by May 13th, 2011. If you have any questions, please contact Lidia Lopez at (408) 928 1171
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scholarships@mipueblofoods.com