<p> SCHOLARSHIP PLANNING COMMITTEE</p><p>SURVEY OF PROBABLE 2001 GRADUATES</p><p>I believe the youth listed below will be graduating from High School in 2001, is in out of home care, and will/may need scholarship assistance as they pursue higher education.</p><p>I. Identifying information Youth’s Name Date of Birth State Number SS# Address Phone # City State Zip CSW’s Name Phone # Has the youth been referred to the Independent Living Program (ILP)? Yes No If so, ILP Coordinator’s Name What high school does the youth attend? What is the youth’s current Expected high school graduation date Is the youth planning to pursue higher education (College/Trade School)? Yes No If yes, what University/College/Trade School does the youth plan to attend?</p><p>Expected college major? Is the youth in out of home care (relative, group or foster homes and residential facilities)? Yes No If no, was the youth in out of home care after age 16? Yes No Does this youth have any problem with the University/College/Trade School knowing that they are a part of the Federal Independent Living Program (ILP) or ward of the court? Yes No ****************************************************************************** After completing Section I, please send or FAX your information to: Caroline Christian, Scholarship Coordinator 5601 West Slauson Avenue, Suite 125, Culver City, CA 90230 (310) 642-1672 or FAX (310) 410-2590 ****************************************************************************** II. When the youth receives the following documents, please forward them immediately to the CSW, ILP Coordinator and Scholarship Coordinator.  Acceptance letter, proof of registration  Financial aid award (FAA) letter and signed FAA indicating that youth has accepted FAA offer  Report of youth’s anticipated school expenses (tuition, fees, housing, etc.)  Information regarding acceptance of non-DCFS scholarships and the amount</p><p>Signature of Contact Person Telephone # Date</p>