MBF's Commissioner Willy Gort Scholarship Program

Description and Application

Pages 3 & 4 of this form must be filled out entirely

Submit applications to:

Cara Sadira

Miami Bayside Foundation

25 SE 2nd Avenue, Suite 240

Miami, FL 33131

Page 2 of 4

MBF’s Commissioner Willy Gort Scholarship

Program Criteria

ADMINISTRATION OF THE PROGRAM The scholarship is independently managed by the Miami Bayside Foundation (MBF) who receives processes, and evaluates applications. All information and academic records submitted in the application process are kept in strict confidence and retained by the Miami Bayside Foundation.

CONDITIONS OF ELIGIBILITY Applicants must be:

1. Residents of Commissioner Willy Gort/District 1 in the City of Miami (see attached map)

2. United States citizens or permanent residents.

3. Planning to attend or attending George T. Baker Technical College, Lindsey Hopkins Technical College, Miami Dade College or D. A. Dorsey. Continuing/ already enrolled students at the four colleges must have a minimum cumulative GPA of 2.5 to qualify. Programs covered at these schools are listed in addendum.

4. All applicants must have completed the Free Application for Federal Student Aid (FAFSA) unless enrolling in a certificate program below 450 hours that do not qualify for Financial Aid and the Federal Pell Grant and/or applicants without High School Diploma or GED.

THE APPLICATION PROCEDURE Applicants must:

1. Meet all eligibility requirements. 2. Complete the application. 3. Send all application materials together

to: Cara Sadira

Miami Bayside Foundation 25 SE 2nd Avenue, Suite 240

Miami, FL 33131 THE SELECTION PROCESS The determinations will be made using the applicants’ abilities to demonstrate dedication to scholarship; their participation and excellence in school and community activities; and the students’ personal statements defining goals and exhibiting energy and dedication to a plan.

THE ACADEMIC AWARDS MBF’s Commissioner Willy Gort Scholarship Program is expecting to award $200,000 in scholarships in the 2016-17 academic year. The scholarship covers the tuition, fees, and course material for eligible students. An additional stipend of $500 per trimester will be available for students who qualify.

ANNOUNCEMENT & DISTRIBUTION OF AWARDS Recipients will be notified on a rolling basis. RESPONSIBILITIES OF THE APPLICANTS Applicants to the MBF’s Commissioner Willy Gort Scholarship Program should remember that it is their sole responsibility to:

1. Gather and submit all information necessary for the Miami Bayside Foundation to select the recipients.

2. Ensure that all material is sent to the Miami Bayside Foundation.

FOR ADDITIONAL INFORMATION Contact: Cara Sadira

Miami Bayside Foundation (305)379-7070 Ext.204 Cara@MiamiBaysideFoundation.org

Page 3 of 4

Miami Bayside Foundation’s Commissioner Willy Gort Scholarship Program

1. Please print or type all information. Do not forget your Social Security number.

2. If space provided is inadequate, please attach additional papers to the application.

3. School, community and work experience relating to the last two years. 4. All data you submit in support of this application becomes property of the Miami Bayside Foundation.

5. Make sure you include all the information required.

APPLICANT DATA

Ms. Mr.

First Name:_____________________ MI:______ Last Name:_____________________ Suffix:____

Street Address:______________________________ City:__________ State:______ Zip Code:_______

Social Security No.:______-_____-______ Home Phone:__________________

Cell Phone:_________________ Email:_____________________________________

PARENT DATA (if under 21)

Ms. Mr. Mrs.

First Name:_____________________ MI:______ Last Name:_____________________ Suffix:____

Work Phone:__________________ Home Phone:________________ Cell Phone:________________

Email:_____________________________________________________________

If different from applicant’s address

Street Address: ___________________________ City: ____________ State: ____ Zip Code:________

HIGH SCHOOL DATA (If graduated in last 12 months)

Cumulative GPA: _________ (on a unweighted 4.0 scale) Rank in class:_______ out of_______

School Name: _____________________________________ School Phone: ___________________

Street Address: _________________________ City: _____________ State: ____ Zip Code:_______

Principal’s Name: _______________________________________________________________

Email: ________________________________________________________________________

Expected graduation date: _________________________

COLLEGE DATA

Which College will you be or are you currently attending:___________________________________

Which Program: ____________________________________________________________________

Expected start date: _____________________________

SPECIAL NOTE

Applicants must meet all eligibility requirements and submit an official transcript of grades.

Page 4 of 4

School and Community Service Activities List all school and community activities for the last two years.

Activity Years Honors/Award

Work Experience List all work experience, part and full-time for the last two years.

Position From Mo/Yr to Mo/Yr Hours per week

Statement of Goals and Aspirations Use this space to write a statement that reflects your dedication to scholarship and your participation and excellence in both school and community activities. Additionally, state why you wish to continue your education; define you career goals and your plan for achievement.

The signatures below affirm that all the information provided in this application and supporting documents is true and complete to the best of our knowledge. If requested, we will provide proof. Failure to do so shall invalidate this application and result in the termination of any aid granted.

Signature of Applicant Date Signature of Parent/Guardian Date If under 21 _______________________________________________________ Signature of Principal (If graduated from High School in 2016) Date

Your request becomes valid only when this application and all supporting documents are submitted to the Miami Bayside Foundation.

Addendum

List of Programs D.A. Dorsey Technical College: Pharmacy Technician Automotive Service Technology Computer Systems and Information Technology Medical Billing and Coding Patient Care Technician Pharmacy Technician Private Security George T. Baker Aviation Technical College: Aircraft Airframe & Power plant Technician*** Avionics Technician*** Lindsey Hopkins: I470203 Air Conditioning, Refrigeration and Heating Technology C410400 Cabinetmaking I460312 Electricity I480203 Commercial Art Technology K500100 Fashion Technology and Production Services E300100 Early Childhood Education H170106 Dental Assisting H170692 Patient Care Assistant* ** H170302 Phlebotomy* ** H170605 Practical Nursing H170211 Surgical Technology * N100500 Commercial Foods and Culinary Arts* V200404 Nutrition and Dietetic Services* ** N900100 Dietetic Management and Supervision* ** I120424 Facials Specialty* ** I120414 Nails Specialty* ** Y100200 Computer Systems and Information Technology* I470608 Automotive Service Technology* - Marine Service Technology* Miami Dade College Associate Degrees: 1252080100 Financial Services 1252090100 Hospitality and Tourism Management 1252140100 Marketing Management 1351080601 Physical Therapist Assistant 1351080800 Veterinary Technology 1351091200 Physician Assistant 1351100405 Medical Lab Technology 1351380100 Nursing RN 1511090103 Networking Services Technology 1552020102 Office Administration 1611080102 Digital Media/Multimedia Technology

Addendum

1611080300 Graphics Technology 1615040101 Biomedical Engineering Technology 1626120100 Biotechnology 1650060213 Film Production Technology 1743020100 Fire Science Technology (FESHE Model) College Credit Certificate - Health Sciences: 63028 Emergency Medical Technician 63029 Healthcare Informatics Specialist 63016 Nuclear Medicine Technology Specialist 63027 Paramedic College Credit Certificate: 65077 Accounting Technology Management 65078 Addiction Studies 66030 Air Cargo Management 63012 Airline/Aviation Management 63017 Airport Management 68000 Automation 65045 Banking Management 65044 Banking Operations 65043 Banking Specialist 60002 Biotechnology 66025 Building Construction Specialist 65098 Business Entrepreneurship 65097 Business Entrepreneurship - Social Entrepreneurship 65041 Business Management - Management 65042 Business Management - Small Business Management 65021 Business Operations - Accounting/Budgeting 65022 Business Operations - Business Management 65024 Business Operations - Finance 65025 Business Operations - Human Resources 65026 Business Operations - International Business 65027 Business Operations - Marketing 65031 Business Operations - Small Business 65010 Business Specialist - Accounting/Budgeting 65011 Business Specialist - Business Management 65013 Business Specialist - Finance 65014 Business Specialist - Human Resources 65015 Business Specialist - International Business 65016 Business Specialist - Marketing 65020 Business Specialist - Small Business 65059 Chef Apprentice 66050 Cisco Certified Network Associate (CCNA) 66070 Computer Aided Design Assistant 66071 Computer Aided Design Operator 66045 Computer Programmer - Business Applications 66036 Computer Programmer - Mobile Applications Development 66033 Computer Specialist 66072 Crime Scene Technician

Addendum

65060 Culinary Arts Management Operations 60004 Early Childhood Education - Administrator 60003 Early Childhood Education - Preschool 69000 Educator Preparation Institute 65099 Entrepreneurship 63024 Florida Funeral Director 65051 Food & Beverage Management 65058 Food and Beverage Operations 65057 Food and Beverage Specialist 66037 Help Desk Support Technician 66074 Homeland Security 63025 Horticulture Professional 63026 Horticulture Specialist 67014 Infant/Toddler Specialization 66044 Information Technology Support 68011 Intermodal Freight Transportation 68010 International Freight Transportation 64051 Interpretation Studies 68001 Lean Manufacturing 65008 Marketing Operations 66032 Microcomputer Repairer/Installer 66046 Microsoft Certified Database Administrator 62004 Mortgage Finance 66035 Network Server Administration 66034 Network Systems Developer 66048 Oracle Certified Database Administrator 66049 Oracle Certified Database Developer 66028 Passenger Service Agent 65048 Rooms Division Management 65056 Rooms Division Operations 65055 Rooms Division Specialist 64050 Translation Studies 66051 Web Development Specialist Advanced Technical Certificate: C6028 Biotechnology C6029 Biotechnology - Bioinformatics C6030 Biotechnology - Chemical Technology C6027 Certified Flight Instructor Career Technical Certificate: 59002 Air Conditioning, Refrigeration, & Heating Technologies Apprenticeship 57003 Bail Bond Agent 55023 Business Computer Programming 56004 Commercial Art Technology 57014 Community Service Officer/Police Service Aide 57020 Correctional Officer - County 57021 Correctional Officer - State

Addendum

57016 Crossover from Correctional Officer to Law Enforcement Officer 59000 Electricity Apprenticeship 56002 Electronic Technology 57004 Fire Fighter Minimum Standards 59001 Fire Sprinkler Apprenticeship 57022 Florida CMS Law Enforcement BRT 52001 Insurance Marketing 53029 Massage Therapy - Accelerated Option 53029 Massage Therapy - Generic Option 53029 Massage Therapy - Transitional Option 53027 Medical Assisting 53028 Medical Coder/Biller 53026 Medical Record Transcribing 57024 National Parks Service - Seasonal Law Enforcement Training Program (SLETP) 55024 Network Support Services 55022 PC Support Services 53025 Pharmacy Technician 53024 Phlebotomy Technician 59004 Plumbing Apprenticeship 57023 Private Investigator Intern 57006 Private Security Officer 59003 Sheet Metal Fabrication Technology - Apprenticeship 56008 Television Production - Training for Manufactured Construction (TRAMCON) *** * Available for students without a High School Diploma or GED ** Program is a short-term certificate program of less than 450 hours *** Applicants without a high school diploma or GED must pass the Test for Adult Basic Education

(TABE) in order to enroll in program

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SW 63

RD C

T

SW 3RD ST

SW 19TH RD

NW 16TH STNW

46TH

AVE

NW 15TH ST

NW 19TH ST

SW 1ST ST

NW 18TH TER

NW 16TH TER

NW 18TH ST

NW 4TH TER

SW 57

TH C

T

NW 41ST ST

NW 32

ND C

T

NW 33

RD C

T

ANTIQUERA AVE

NW 42ND ST

SW 7TH ST

NW 42ND ST

SW 5TH TER

NW 44TH ST

SW 9TH ST

NW 31ST ST

SW 9TH TER

NW 43RD ST

NW 9T

H CT

SW 6TH ST

SW 20

TH AV

E

SW 2ND TER

NW 24

TH C

T

SW 4TH ST

WALL

ACE

ST

SW 3RD ST

NW 13TH ST

NW 45TH ST

NW 12TH TERNW 12TH ST

UNNA

MED

SHER

IDAN

DR

NW 17

TH C

T

I 95 OFF RAMP W

ALBE

RCA S

T

SE 8TH PL

NW 57TH

CT

NW 41

ST AV

E

SW 31

ST C

T

SW 31

ST AV

E

CAPR

I ST

NW 9T

H AV

E

NW 24TH ST

CARMONA AVE

MONT

EREY

ST

NW 23

RD C

TNW

24TH

AVE

NW 24

TH C

TNW

25TH

AVE

NW 26TH ST

PIZAR

RO S

T

NW 27TH ST

NW 55

TH CT

NW 19TH ST

NW 25TH ST

NW 17

TH PL

NW 26TH ST

NW 34TH ST

NW FLAGLER TER

NW 51ST ST

NW 31ST ST

SW 4TH ST

SW 35

TH AV

E

NW 31ST ST

SW 1ST ST

NW 33RD ST

NW 44

TH AV

E

NW 32ND ST

NW 50TH ST

NW 59

TH AV

E

NW 43

RD C

T

NW 30TH ST

NW 27

TH C

T

NW 28

TH AV

E

NW 22

ND C

T

NW 51ST TER

SANT

IAGO

ST

NW 58

TH C

TNW

58TH

AVE

NW 57

TH C

T NW 4TH ST

NW 6TH ST

NW 29TH TER

NW 18TH TER

SW 11TH ST

NW 51ST ST

NW 1ST ST

NW 50

TH AV

E

NW 33RD ST

NW 51ST TER

SW 1ST ST

NW 2ND TER

NW 30TH ST

SW 2ND TER

NW 45TH ST

NW 49TH ST

NW 23RD TER

NW 27TH ST

SW 5TH ST

SW 2ND ST

NW 43RD ST

SW 62

ND C

T

NW 45TH ST

SW 3RD ST

NW 36

TH AV

E

NW 48TH TER

SW 1ST ST

NW 18

TH AV

E

NW 26TH ST

SW 64

TH C

T

NW 37TH ST

SW 3RD ST

NW 27TH ST

NW 48TH ST

SW 1ST ST

UNNA

MED

SE 10

TH C

T

NW 19TH ST

NW 33RD ST

NW 37TH ST

NW 25

TH AV

E

NW 35TH TER

NW 18

TH C

T

NW 33RD ST

NW 49TH ST

UNNAMED

NW 24TH ST

NW 47TH TER

NW 23RD ST

NW 51ST ST

NW 21ST TER

SW 2ND TER

NW 47TH TER

NW 19TH TER

NW 31ST ST

NW 44TH ST

NW 47TH ST

RAGA

N DR

NW 44TH ST

NW 39TH ST

NW 38TH ST

NW 30

TH PL

NW 22ND ST

NW 22ND ST

NW 21ST TER

SW 5TH TER

NW 40TH ST

SE 11

TH AV

E

SW 11TH ST

NW 19TH TER

NW 32ND ST

NW 6TH ST

NW 24TH ST

LEE

DR

NW 32ND ST

NW 28TH ST

NW 2ND TER

NW 23RD ST

SW 11TH ST

NW 35

TH C

T

NW 40

TH AV

E

NW 30TH ST

NW 41

ST AV

E

NW 20

TH AV

E

NW 21

ST C

T

NW 26

TH AV

E

NW 17TH ST

NW 29TH STNW 29TH ST

NW 45TH ST

NW 39TH ST

SW 30

TH AV

E

UNNAMED

NW 29TH TER

NW 22

ND C

T

NW 24TH STREET RD

NW 8TH ST

NW 21ST TER

NW 20

TH AV

E

NW 62

ND AV

E

NW 12TH TER

SR 112 ON RAMP W

NW 17

TH C

T

SR 836 OFF RAMP N

NW 19

TH C

T

NW 19

TH AV

E

NW 21

ST C

T

NW NORTH RIVER DR

NW 9TH ST

NW 31ST ST

I 95 ON RAMP N

FONSECA AVE

NW 5TH STNW 6TH ST

UNNAMED

VERAGUA AVE

MARABELLA AVE

NW 21ST ST

MONTILLA AVE

NW 29TH ST

NW 24

TH C

T

I 95 ON RAMP S

NW 29

TH C

T

NW 13TH ST

SR 836 OFF RAMP W

SR 112 ON RAMP W

NW 14TH ST

NW 12TH STUNNAMED

SW 51

ST C

TSW

51ST

PL

NW 26

TH AV

E

NW 27

TH C

T

NW 31ST ST

NW 24TH ST

I 95 ON RAMP

N

SW 51

ST AV

ESW

50TH

AVE

UNNAMED

NW 30

TH AV

ENW

30TH

CT

SW 48

TH C

T

SR 836 OFF RAMP S

NW 25

TH C

T

NW 23

RD PL

NW 12TH STREET DR

NW 26TH ST

NW 48

TH PL

NW 27TH ST

I 95 ON RAMP N

SR 836 ON RAMP WSR 836 OFF RAMP E

I 95 ON RAMP N

I 95 OFF RAMP W

UNNAMED

I 95 R

AMP

N

UNNAMED

NW 29

TH AV

E

NW 39

TH C

T

NW 10

TH AV

E

NW 25

TH AV

E

UNNA

MED

SW 39

TH AV

E

NW 32

ND PL

NW 31

ST AV

E

UNNAMEDUNNAMED

SW 60

TH AV

E

NW 7T

H CT

UNNA

MED

UNNA

MED

NW 23

RD AV

E

NW 62

ND AV

E

NW 36

TH AV

E

NW 5T

H AV

E

NW 21

ST AV

E

NW 4T

H CT

SW 52

ND C

T

SW 25

TH AV

E

NW 18

TH AV

E

NW 15

TH AV

ENW

15TH

CT

NW 36

TH AV

E

NW 39

TH AV

E

SW 5T

H AV

E

NW 18

TH AV

E

SW 4TH ST

NW 35

TH AV

E

NW 28

TH AV

E

NW 9T

H AV

E

SE 9T

H AV

E

NW 15

TH AV

E

SE 10

TH AV

E

SW

7TH ST

NW 15

TH AV

E

NW 49

TH AV

E

NW 37

TH AV

E

NW 48

TH AV

ESW

48TH

AVE

NW 48

TH PL

N W 6TH

AVE

NW 6T

H CT

NW 30

TH AV

E

UNNAMED

NW 13TH ST

NW 21

ST AV

E

SW 33

RD AV

E

NW 56

TH AV

E

NW 18

TH AV

E

NW 18

TH C

T

NW 42

ND C

T

SW 29

TH C

T

NW 16TH ST

SR 112 ON RAMP E

NW 11

TH P

L

MIAD CIR

SW 59

TH C

T

NW 24

TH C

T

NW 60

TH C

TNW

60TH

AVE

NW 59

TH C

T

SW 60

TH C

T

SW 67

TH C

T

NW 25

TH AV

E

SW 30

TH AV

E

SR 112 ON RAMP W

SR 112 ON RAMP

NW 23

RD CT

NW 65

TH AV

E

I 95 OFF RAMP E

SR 836 OFF RAMP N

UNNAMED

UNNA

MED

SR 836 ON RAMP W

City Boundary!(Ä Elementary School!(Ä Middle School!(Ä High SchoolIC HospitalÆL Police Station

²µ Fire Stationñ Net Service Center Office

City StreetsCity ParksWater BodiesCommission District 1

C o m m i s s i o n D i s t r i c t 1Commissioner: Wifredo (Willy) Gort

Project: District 1Prepared by: Y. Kebede, ITDC:\GISPROJECTS\REQUESTS\CommissionDistrict\Dist4_2011_10_Dist1_small

2

5

4

13

District 1

´0 4,3002,150 Feet