NANKA (SOUTHERN CALIFORNIA) YAMAGUCHI KENJINKAI

APPLICATION FOR SCHOLARSHIP

Please print. If using a computer, use TAB key
Date:_______________________

Applicant Name:______________________________________________________________________
Last
First
Middle
Address: ____________________________________________________________________________
City: __________________________________ State: ______________

Zip: ___________________

Home Phone:________________ Cell:________________ Email:_____________________________

Date of Birth:_______________________

Place of Birth:___________________________________

Fathers Name_____________________________ Occupation:________________________________

Mothers Name____________________________ Occupation:________________________________
Name & relationship of your Yamaguchi Prefecture blood relative(s):
___________________________________________________________________________________
Your High School:___________________________________

Date of Graduation:________________

H.S. Address:_________________________________________________________________________
City:________________________________ State:_______
GPA:__________

SAT Score:________

Zip:______________

Class rank:__________ Size of Graduating Class:_______

Any scholarship awards, honors received or membership in service organizations?

(Use back or another sheet, if needed)

University to attend:____________________________________
Major:______________________________
Future academic plans (use back or separate sheet, if needed):

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Enrollment Date:______________

Knowing Your Family Roots

You are encouraged to talk to your parents and grandparents as you answer the following questions:
Which city/cities in Yamaguchi Prefecture is/are your relative(s) from?
________________________________________________________________________________
When was/were he, she or they born?__________________________________________________
(If you dont know the year, the decade will suffice)

What did your Yamaguchi relative(s) do for a living in Japan?

________________________________________________________________________________
When did your Yamaguchi relative(s) come to the United States? ____________________________
What did he or she do for a living in the United States?
________________________________________________________________________________
What is a Prefecture?_______________________________________________________________
What is the capital of Yamaguchi Prefecture? ____________________________________________
Name three things Yamaguchi Prefecture is known for:
________________________________________________________________________________

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___ Essay Question ___

Please write a 3-paragraph essay discussing one of the following questions which applies to you:
1) If you ever have the opportunity to travel to Yamaguchi Prefecture, what sites would you choose to
visit and why?
2) If you have already had the opportunity to visit Yamaguchi Prefecture, what were your fondest
memories and why?

Essay
(Please type your 3-paragraph essay below)

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Participation in Nanka Yamaguchi Kenjinkai Events

Have you ever attended any of the following Nanka Yamaguchi Kenjinkai events?
Use the X key for Yes or No.
1. New Years Luncheon?
2. Annual Picnic?

Yes:_____

Yes:_____

No:_____

No:_____

3. Tanabata Festival in August during Nisei Week?

Yes:_____

4. Making of Kazari (decoration) for the Tanabata Festival?

No:_____

Yes:_____

5. Keiro-No-Hi, our annual visit to the elderly, at Keiro Nursing Home?

6. Annual Bowling Tournament?
7. Past Memorial Services?

Yes:_____

Yes:_____

8. Past Cherry Blossom Festivals?

No:_____

Yes:_____

No:_____

No:_____

No:_____

Yes:_____

No:_____

Which of the above (except for #7 & #8) would you be interested in attending in the future?

Teachers Letter of Recommendation

Please attach a letter of recommendation from one of the teachers at your school.
Full Name of Teacher/Subject:_____________________________________________________
Teachers contact number:____________________________

Applicants Signature________________________________________________________

Please read the Rules document for deadline and further instructions.

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