SCHOLARSHIP APPLICATION COVER PAGE

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1 1 SCHOLARSHIP APPLICATION COVER PAGE APPLICANT'S NAME: VERMILION STUDENT ID# (if applicable): A current transcript is required to be eligible for consideration. Your signature below will authorize us to request a transcript from the Vermilion Records Office. If you will be a new student at Vermilion in , please include a high school transcript or a transcript from the last college you attended. I authorize Vermilion to release my academic and financial information for the purpose of scholarship selection. I further authorize the individuals listed as references on page two of the application to complete and submit the recommendation forms to the VCC Foundation. In addition, I authorize the VCC Foundation to release information and photos announcing my scholarship for publicity purposes (i.e. hometown newspaper, Foundation website). If selected for a scholarship, I authorize Vermilion to release proof of enrollment (i.e. student term schedule). I certify that the information provided in this scholarship application is correct to the best of my knowledge and that I am currently or will be enrolled as a student at Vermilion. SIGNATURE: DATE: NON DISCRIMINATION STATEMENT Vermilion Community College Foundation assures that no person shall, on the grounds of race, color, national origin, creed, religion, gender, marital status, sexual orientation, status with regard to public assistance, age, or disability, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination while under consideration to receive a scholarship.

2 SCHOLARSHIP APPLICATION Scholarship applications must be typed. We are unable to accept handwritten applications. APPLICANT'S NAME: LOCAL ADDRESS: CITY: STATE: ZIP: PERMANENT ADDRESS: CITY: STATE: ZIP: PHONE: ADDRESS: ANTICIPATED FIELD OF STUDY: ANTICIPATED NUMBER OF CREDITS FOR FALL SEMESTER : VERMILION START DATE: VERMILION PROJECTED COMPLETION DATE: HIGH SCHOOL/CITY & STATE: H.S. GRADUATION DATE: In the Fall of 2016, I will be: new to Vermilion I will be graduating from Vermilion in the spring of 2016 and transferring to: or a returning second year Vermilion student other please specify: ( Name of college or university) REFERENCES: You are required to list two professional references (i.e. instructor, employer) at least one must be a Vermilion instructor who knows your work well. If you will be a new student at Vermilion, at least one of your references must be a high school teacher or an instructor from the last college you attended. List the names of your two references and their phone numbers below. They each must complete the Scholarship Recommendation Form. Print two copies of the form and give one to each of your references to complete. Recommendations from personal references (i.e. family members, friends) will not be accepted. NAME: PHONE #: NAME: PHONE #:

3 PLEASE RESPOND TO THE FOLLOWING QUESTIONS: (Completion of this section is optional, however failure to do so may prohibit you from being considered for scholarships that have specific eligibility criteria.) 1. Education history. Check all that apply: G.E.D. High School Diploma Post Secondary Other please specify: 2. Are you a veteran? Yes No If yes, please list your branch, location, and dates of military service 3. Are you the parent, spouse, child, or grandchild of a veteran? Yes No If yes, please list your family member s branch, location, and dates of military service 4. Are you a non-traditional student? (Defined as an individual who is over age 24, or married, or has dependents of their own, or has completed military service) Yes No 5. Are you of Native American heritage? Yes No 6. Will you be a part-time student (less than 12 credits) in the fall of 2016? Yes No Next Page

4 Please respond to the following questions. 1. COMMUNITY INVOLVEMENT: List community activities in which you have been involved. Be specific. 2. SCHOOL INVOLVEMENT: List school activities in which you are currently involved. Be specific. 3. AWARDS/RECOGNITION: List awards/recognition you received during and after high school. Be specific.

5 4. MAJOR FIELD OF STUDY: List your current or expected major field(s) of study and your reasons for choosing this field(s). 5. WORK EXPERIENCE: List full and part-time work experiences and dates of employment. Be specific.

6 6. PERSONAL STATEMENT: Briefly explain the reasons you deserve consideration for a scholarship. Please include information about the accomplishments you consider significant in your life, obstacles that have affected your pursuit of educational goals and how you have overcome these obstacles, and what future goals you have set for yourself 7. CURRENT FINANCIAL SITUATION: Describe your current financial situation. (For example, are you living on your own with no financial assistance from your parents? Do you have dependents for which you contribute support? Address other factors affecting your financial situation.)

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