Scholarship Application for New & Continuing UCC STUDENTS

Transcription

1 Scholarship Application for New & Continuing UCC STUDENTS IMPORTANT! You must complete the Free Application for Federal Student Financial Aid (FAFSA), if you wish to be considered for scholarships that require "financial need, even if you believe you won t qualify. You may apply online at: Complete this application if you: Plan to attend UCC for the academic year. Scho larship Awards Begin Fall Term 2015 Scholarship Name Full Legal Name: (Please Print) First Middle Initial Last Mailing Address City MAJOR 1: Must be consistent with official registration records. MAJOR 2: Must be consistent with official registration records. Undecided College Transfer (transferring to another college attending UCC) Program: CUM GPA: after State County Date of Birth Zip Telephone Number MM/DD/YEAR CUM High School GPA: Still in high school: YES NO Graduation year: Homeschool GPA: (See calculating Homeschool GPA instructions) GED Score Address *This will only be used for UCC Scholarship Office contact purposes. UCC Student ID Number: (if available) Social Security Number: (if no ID # available) Number of GED tests completed: FAFSA Completed YES Full time Part Time NO Providing your social security number is voluntary. If you do so, the Scholarship Office will only use your social security number for keeping records, doing research, reporting, and in crediting any awards to your student account.)

2 Referring to the list of scholarship criteria below, mark ANY item for which you qualify. INDICATE IF YOU ARE: (Place where applicable) Current of former parent of a child at the Family Honorably discharged from Armed Forces 1 42 Development Center Active parent in Family Development Center for at least one Female 2 43 year Pursuing a degree in Civil Engineering and going on to OIT Male 3 44 or OSU Enrolled in or recently completed the Developmental Ed Douglas County Resident 4 45 Program Are you an employee or dependent of Pepsi Cola of Douglas County High School graduate 5 46 Roseburg? 6 Roseburg High School graduate 47 Majoring in Theater 7 South Umpqua High School graduate 48 Resident of Glide School District Fire Science Student from Do. Co. Fire District #2 or City of Glide High School graduate 8 49 Sutherlin Fire Dept. 9 Sutherlin High School graduate 50 Enrolled in Dental Assisting Program 10 North Douglas High School graduate 51 Under the age of Elkton High School graduate 52 Oregon Resident 12 Yoncalla High School graduate 53 Reside in the Umpqua Zip Code (97486) Graduate from a High School located within a 35 mile 13 radius of Roseburg 54 Interested in becoming a teacher 14 Active Volunteer/Community Involvement 55 Enrolled in the study of Ceramics Seeking a certificate or degree in Early Childhood 15 Education 56 Enrolled in the Welding program 16 Lineal descendant of Kienows Food Store employee 57 Enrolled in the CIS program 17 Nursing Student, 1 st year 58 Pursuing a course of study in Music Nursing Student, 2 nd Majoring in Automotive, Business Management, Business year Marketing, Industrial Tech or Mechanical Engineering Pursuing a course of study in Welding, CIS, or Automotive Majoring in Art Technology 20 Majoring in Business 61 Member of the UCC Computer Club Majoring in Science (Biology, Chemistry, Geology or Majoring in Education Physics) 22 Majoring in Agriculture 63 Enrolled in the EMT Program 23 Majoring in Health-related field 64 Enrolled in a course of study for training timber workers Part or Full Time Employee of Garden Valley Retirement Majoring in Forestry, Fisheries or Wildlife Science Residence 25 Enrolled in Automotive Technology Program 66 Have a disability that affects education 26 Enrolled in Paralegal Program 67 GED/AHSD student at the Woolley Center Resident of North Douglas, Elkton, or Yoncalla School Enrolled in Viticulture & Enology Program District 28 Enrolled in a 2 year program of study 69 Enrolled in Construction Technology Program 29 Pursuing a degree in Criminal Justice or Policy Reserve Training 70 Have completed one term on your own with no federal aid, scholarship, or grant assistance 30 Pursuing a degree in Engineering 71 Applied to the Nursing Program 31 First year student, attending full-time 72 Enrolled in a Science or Technology Program 32 Second year student, attending full-time 73 Part-time student 33 Current or recent resident of BPA or Casa de Belen 74 Full-time student 34 Resident of Sutherlin 75 Wolf Creek Job Corps Student with GED Resident of South Douglas County (Azalea, Canyonville, 35 Days Creek, Glendale, Myrtle Creek, Riddle or Tiller 76 Minimum of 12 credits completed 36 Completed a minimum of 30 credits 77 Second year student 37 Completed a minimum of 36 credits 78 Single parent 38 From Oregon, Washington, Idaho or Alaska 79 Graduate of Roosevelt High School (Portland) 39 Overcome a hardship 80 Resident of Tenmile, Olalla, or Lookingglass 40 Student starting over in their career 81 Beginning education later in life 41 Active interest in 4-H or FFA

3 Activities Chart Name: Dates From-To A. School/Community/Family Activities Time Spent Hours per Week / Month Total Hours Responsibility / Accomplishments C. Work History (3 most current or most relevant to your educational goals)

4 Personal Statement (must be at least 300 words but no more than 400 words) Your personal statement should include reference to some, or all, of the following: What are your educational plans? Describe an event or barrier that has impacted your life and how it has affected you in relationship to your educational goals. Tell us why we should give you a scholarship. **Your essays will be judged on content and persuasiveness, as well as grammar and neatness.**

5 In the next academic school year (Summer term 2015 through Spring term 2016), I will be attending UCC for the first time I will be continuing at UCC* * If current UCC student, anticipated program completion date: Transferring from another college EDUCATION HISTORY 1 List schools attended and/or training received (high school and beyond), list most current first. School City, State Dates Attended Field of Study Graduation date/credits earned/degree earned GPA 2 3 If graduating from High School in 2015: Name of High School SCHOLARSHIP HISTORY: I have never received a UCC Scholarship I was previously awarded a UCC Scholarship: Name of scholarship and the year scholarship was awarded Telling your story may help the Scholarship Office s efforts to secure additional scholarship funding. If you agree to the following statement, please check the box: By checking here, I authorize the UCC Scholarship Office to use my photograph and/or publish stories or use quotes for purposes deemed appropriate by the College, and/or the Scholarship Office. This is optional and will not affect your application. I authorize the release of information on this application and other necessary academic and financial information to the UCC Scholarship Office, individual donors and selection committees. I certify that the information I have provided is true and complete, to the best of my knowledge. I give permission to release for publication my name, the amount and the source of any scholarship funds I may be awarded. *PLEASE READ APPLICATION REQUIREMENTS ON FOLLOWING PAGE* Applicant s Signature: Date: