Collegiate 100 Program Information Sheet



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What is COLLEGIATE 100? Collegiate 100 Program Information Sheet The Collegiate 100 is an auxiliary organization that extends the 100's mission on college and university campuses across America. Students who are in good academic standing and who have a passion to mentor and deliver community service, are eligible to become members of a Collegiate 100 chapter. Each chapter is a responsible, productive and cooperative segment of 100 Black Men, the college and surrounding communities. At Hillsborough Community College, Collegiate 100 is a district-wide initiative open to all students on all five of campuses. The initiative affords students the ability to engage in mentoring and community service opportunities. C- 100 members have an opportunity to develop relationships with campus advisors as well as members of the professional association of the 100 Black Men of Tampa Bay, Inc. (100BMTB) What are the eligibility criteria to participate in COLLEGIATE 100? Applicants must be enrolled at Hillsborough Community College. Applicants must be US Citizens or must meet the requirements of an eligible non-citizen as defined by the Federal Financial Aid Program. Applicants must have completed at least 12 credit hours course work at HCC and cannot be in their last semester of their program. All members must also complete a Free Application for Federal Student Aid (FAFSA) each academic year by March 1. What are the program benefits? Open to all HCC students in good academic standing Fosters relationships with campus advisors and members of 100 Black Men of Tampa Bay, Inc. Mentor opportunities with young men in local elementary, middle and high schools Leadership training and scholarship opportunities available Participate in local, and national events and conferences What are the requirements of the Collegiate 100 Program? Each member should have a minimum 2.3 to participate, 2.5 GPA to travel or hold an office, and at least 9 credit hours per semester. Each member must attend (at least) two of the four college wide Collegiate 100 Seminars (one in the Fall Semester and one in the Spring Semester) Each member must complete the 100 Black Men of America online mentoring training in order to mentor students in the public school system, and commit to mentoring African American Males.. Each member must complete a volunteer applications with the School District of Hillsborough County in order to mentor for any public school. Each student must complete 75% of mentoring sessions, chapter meetings, schedule community service with required documentation and submit all volunteer hours to their advisors Members must submit course schedule, progress towards degree, tentative academic plan of study towards degree completion and transfer an upper level institution to the program coordinator each semester, and an admission letter upon completion of degree. For further information please contact Hillsborough Community College Office of Equity and Special Programs bcockfield@hccfl.edu or 813-253-7037

Collegiate 100 Program Application Instructions 1. Complete the online Collegiate 100 Application. 2. Submit at least one letter of recommendation (attached) completed by a faculty, staff or college administrator. Recommendations should be sealed. 3. Attach a copy of your unofficial transcript. APPLICATION DEADLINE: Friday, September 18 th, 2015 Submit the completed application and any additional materials to: Collegiate 100 and Hope Scholars Program Office of Equity and Special Program, Room 713 Hillsborough Community College 39 Columbia Dr. Tampa, FL 33606 813-253-7037 bcockfield@hccfl.edu Incomplete applications will NOT be reviewed.

Program Application PERSONAL INFORMATION Name: Address: City/State/Zip Home Phone: Cell Phone: Personal Email: HCC Email: Student I.D. Date of Birth: Gender: Race/Ethnicity: County of Birth: Shirt Size: S M L XL XXL 3XL 4XL Please answer the questions below by checking the appropriate box: Are you a U.S. Citizen or do you meet the requirement of an eligible non-citizen as defined by the Federal Financial Aid Program? (Information can be found at www.fafsa.ed.gov) Yes INCOME INFORMATION Do you qualify for Financial Aid: Yes Have you completed the 2014/15 FAFSA? Yes Are you receiving any other scholarships (If yes, please state)? PROGRAM INFORMATION Degree (AA or AS)? Program of Study (Major) HCC GPA: College-Credit Hours Completed: Prep-Credit Hours Completed: Are you registered for any prep courses this semester? Yes Campus you mostly attend: Dale Mabry Ybor City Brandon Plant City South Shore What University do you plan to attend upon graduation from Hillsborough Community College? FIRST GENERATION

Please answer the questions on by the next page with an X on the appropriate line: Are you a first generation college student? (Neither of your parents graduated from a four-year college or university) Yes What is the highest level of education completed by your parents? Mother: No College Some College Father: No College Some College Completed College N/A Completed College N/A EXTRA CURRICULUM ACTIVITIES College Activities: Community Activities: Work Experience: Current Employer: # of hours work per week? My signature indicates that I understand the Collegiate 100 Program requirements and the information contained in this application is true to the best of my knowledge. Signature: Date: / / APPLICATION DEADLINE: Friday. September 18 th, 2015 Submit the completed application and any additional materials to: Collegiate 100 and HOPE Collegiates Programs Office of Equity and Special Program, Room 713 Hillsborough Community College 39 Columbia Dr. Tampa, FL 33606 Incomplete applications will NOT be reviewed Hillsborough Community College is an Equal Access, Equal Opportunity institution. Programs, activities, and facilities of the College are available to all on a nondiscriminatory basis, without regard to race, color, religion, sex, age, disability, marital status and national origin. Questions pertaining to education equity, equal opportunity or equal access should be addressed to Dr. Joan Holmes Special Assistant to the President, Office of Equity and Special Programs jholmes16@hccfl.edu

Recommendation Form One recommendation form completed by the applicant s professor, faculty, staff or college administrator is mandatory to apply for the Collegiate 100 program. Additional recommendations are encouraged. Letters are welcomed. Recommendations should be sealed. Applicants Name: Name of person completing this form: Title: Campus: Capacity in which you know the applicant: Please rate the applicant on the qualities listed below using the following numeric scale: 5 Excellent 4 Good 3 Average 2 Fair 1 Poor Initiative Career Goals Academic Self-Discipline Please discuss briefly why you believe this student should be selected as a Collegiate 100 recipient? Please provide further information on the applicant as it pertains to the areas listed above. Additionally, please provide information as to why you are recommending this applicant and their strengths and weaknesses. Print Name: Date: Signature: Title: Email: Phone: