FA101 Scholarship Application.pdf - Baton Rouge Community College

SCHOLARSHIP APPLICATIONInstructions:Step 1: Complete this form in ink and print clearly.Step 2: Complete and submit a Free Application for Federal Student Aid (FAFSA) if this has not been done.Step 3: New and transfer applicants MUST have an official transcript on file in Enrollment Services.Step 4: Submit completed form to the Financial Aid Office by the appropriate deadline indicated below.Fall Term – June 1 st Spring Term – October 15 thSTUDENT INFORMATIONStudent ID:Program of Study:Last Name: First Name: MI: Date of Birth:Address:City: State: Zip Code: Parish:Marital Status(Check One): Single Married Divorced Home Telephone:Cell Telephone:Work Telephone: Email 1: @mybrcc.eduEmail 2:Last high school attended and location:Name:Parish:Address:City, State, Zip:Have you graduated from high school? Yes NoIf Yes, what year?If No, when will you graduate?Other college attended:Check all that apply: US Citizen Louisiana resident STUDENT STATUSBeginning Fall Semester, I will beA first generation student New freshman (no hours at BRCC) Returning student (hours at BRCC) New transfer student (no hours at BRCC) Other (specify):I will be enrolled: Full-time (12 hours or more) Part-time (between 6 – 11 hours) Anticipated BRCC Graduation Date:GRANT/SCHOLARSHIP INFORMATIONI am applying for: BRCC Student Grant* Other Specify Name of Scholarship:Other types of financial aid, scholarships, and/or tuition reimbursement anticipated for this year:* Students applying for the BRCC Grant and/or scholarships must complete their financial aid file.Name of place of employment of parent/legal guardian:Explain briefly why you should be considered for a scholarship and how a scholarship willcontribute to your career and educational goals. Please attach your response.To the best of my knowledge, the information provided in this application is true and complete. I authorize BRCC toshare this application and other relevant information with the BRCC Scholarship Committee and/or donors. Iunderstand that if I am awarded a scholarship, information may be released for publicity purposes or to meetrequirements for receiving funds.Signature of ApplicantDateOFFICE USE ONLYReceived By:Reviewed By:Date:Date:Baton Rouge Community College is an Equal Opportunity/Equal Access EmployerFA101 3/09Original – Financial AidYellow – Student

Baton Rouge Community College is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools toaward the associate degree. Contact the Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Baton Rouge Community College. Educational opportunities are offered by the BatonRouge Community College without regard to race, color, age, national origin, religion, gender, or disability. The Director of DisabilityServices has been designated as the college’s 504/ADA Compliance Officer. Any person with a disability who needs assistance shouldcontact the Director at 225.216.8503, TDD 225.216.8702. Baton Rouge Community College does not discriminate on the basis ofgender in admission to or employment in its education programs or activities. Title IX Coordinator is the Vice Chancellor for StudentAffairs, 201 Community College Drive, Baton Rouge, Louisiana 70806 – 225.216.8068. The Family Educational Rights and PrivacyAct of 1974, as amended (also sometimes referred to as the Buckley Amendment), is a federal law regarding the privacy of studentrecords and the obligations of the institution, primarily in the areas of release of the records and the access provided to these records.Any educational institution that receives funds under any program administered by the U.S. Secretary of Education is bound by FERPArequirements. Institutions that fail to comply with FERPA may have funds administered by the Secretary of Education withheld.BRCC is a member of the Louisiana Community and Technical College System (LCTCS).Baton Rouge Community College is an Equal Opportunity/Equal Access EmployerFA101 3/09Original – Financial AidYellow – Student