Scholarship Application 2015 - 2016

Scholarship Application
2015 - 2016
Serving Richmond and Scotland Counties
P.O. Box 1189, Hamlet, NC 28345
Phone 910.410.1726
By completing this application, you will be considered for all Richmond Community
College Scholarships. Scholarships are available to both part-time and full-time students.
Please print out this application and mail it to the address above (Do not fax). Scholarship
deadline is March 20, 2015. Students should also complete the 2015 - 2016 Free
Application for Federal Student Aid at www.fafsa.gov. Our school code is 005464.
Print Legibly or Type
Full Name (First, Middle, Last) ________________________________________________________________
Date of Birth ___________Email Address __________________________RCC Student ID#_______________
Mailing Address____________________________________________________________________________
City______________________________County____________________State_____________Zip__________
_
Home Phone #______________________ Cell #____________________ Work #________________________
Are you a North Carolina Resident? ______Yes
_____ No
Are you currently a high school student? _____ Yes
______ No
Are you currently enrolled as a student at Richmond Community College? ______Yes
______No
What is your intended Major or program of study? _________________________________________________
What level of education are you pursuing at RCC?
Certificate
Diploma
Associate in Arts
Associate in Science
Associate in Applied Science
How did you earn your high school (or equivalent)?
Diploma
High School
Adult High School
Please list the names and addresses of two references:
_______________________________________________________________________________________
Name
Street Address
City, State
Phone #
_______________________________________________________________________________________
Name
Street Address
City, State
Phone #
Richmond Community College Scholarship Application (page 2): Answering these questions helps us to
better determine which scholarships you might be eligible to receive. Answering ‘No’ to a question does not
disqualify you from competing for and winning a scholarship.
1. Are you a customer, employee, or an immediate family member of a customer or an employee of the Ellerbe
Telephone Company?
a. ______ Yes
b. _______ No
If yes, what relationship? _________________________________________________________________
2. Are you or your family a member of Pee Dee Electric Membership Cooperative?
a. ______ Yes
b. _______ No
3. Are you an employee of the CSX System, child of an employee, or a dislocated employee from CSX?
a. ______ Yes
b. _______ No
4. Are you an employee or a family member of an employee of the City of Hamlet?
a. ______ Yes
b. _______ No
5. Are you an employee or dependent of an employee of Unimin Corporation?
a._____Yes
b.______No
6. Are you or your parents currently employed at a textile industry?
a._____Yes
b.______No
If yes, name the company. _________________________________________________________________
7. Were you or a family member (living or deceased) ever employed in the textile industry?
a._____Yes
b.______No
8. Are you or your parent(s) a graduate of Rohanen High School?
a._____Yes
b.______No
9. Did you pass the 9th grade at Ellerbe Junior High School or 8th grade if you attended after Ellerbe Junior
High was converted to Ellerbe Middle School?
a._____Yes
b._____No
10. Are you an employee or dependent of an employee of Vulcan Materials Company?
a.______Yes
b.______No
Richmond Community College Scholarship Application (page 3): Continued
11. Are you an employee or an immediate family member of an employee of Morrison Youth Institution?
a.______Yes
b.______No
12. Are you a displaced/dislocated worker?
a.______Yes
b.______No
If yes, name of former employer. __________________________________________________________
13. Are you a single parent?
a. ______Yes
b._____No
14. Have you taken and completed History courses at Richmond Community College?
a._______Yes
b.______No
If yes, name the course(s) and grade(s) you made.______________________________________________
15. Do you plan to continue your education after completing your degree at Richmond Community College?
If yes, what college ______________________________________________________________________
Major or field of study___________________________________________(Undecided is a valid response)
16. If you are married, is your spouse presently employed: Yes_____ No ______
Full-time_____ Part-time______
Name of employer______________________________________________________________________
17. If you reported your parent’s income information on your FAFSA, answer this question,
Is/Are your parent(s) employed? Yes________ No_________
Name of employer(s) __________________________________________________________________
18. Are you currently employed in law enforcement in Richmond County?
a._______Yes
b.______No
If yes, which agency? (e.g. Sheriff, Hamlet Police, etc.)__________________________________________
Richmond Community College Scholarship Application (page 4): Essay Questions
Your answers to these questions are important. Please answer as completely as you can.
1. Why did you decide to attend RCC? (250 words, you can attach additional pages if necessary)
2. Why have you selected your current area of study? (250 words, you can attach additional pages if necessary)
3. Describe briefly your short-term and long-term career goals. (250 words, you can attach additional pages if
necessary)
4. Describe your extracurricular activities this can include work experience, church activities, military or
volunteer work. (250 words, you can attach additional pages if necessary)
By signing this, I give permission for the members of the RCC Financial Aid Committee to review my
transcript and to review any financial information on file in the financial aid office. I agree to write a
thank you note to the donor of my scholarship or the RCC Foundation. I acknowledge that I will be
invited to attend the annual scholarship banquet to meet the donor of my scholarship. Attendance at the
banquet is mandatory. The date and time will be announced.
__________________________________________________________________________________________
Signature
Date