Fillable 17 18 Secu Scholarship App (Johnston Community College)

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17 18 Secu Scholarship App (Johnston Community College)

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State Employees’ Credit Union (SECU) Scholarship Application
GUIDELINES:
To be considered for this scholarship program, a student must:
• Be a US citizen, North Carolina resident and present a valid Social Security card and a current NC Driver’s
License or Identification Card.
• Be in one of the following target groups:
o Unemployment insurance claimants
o Unemployed and underemployed adults (Note: Underemployed will be defined as individuals earning
200% below the federal poverty level listed on page three of this application. Preference will be given to
students with limited or no access to financial aid from other programs.)
o Military veterans
o Members of the NC National Guard.
• Documentation of proof of the above will be required (2016 tax return, DD214, current paystub, unemployment
information).
• Enrolling in a short-term training program that leads to a state-regulated or industry-recognized credential that is
offered through Continuing Education.
• Not be a Director, employee, or immediate family member of an employee of the State Employees’ Credit Union
or SECU Foundation.
• If chosen as a finalist, applicant will be contacted for an interview.
• If chosen as a recipient, scholarship recipients must consent to the release of their names and images for
publications written/distributed by the System Office, the local Community College, and/or the State Employees’
Credit Union and its Foundation.
Return applications to:
Johnston Community College, SECU Scholarship Program
Workforce Development Center
135 Bestwood Drive
Clayton, NC 27520
Applications are due no later than 12:00 noon
Friday, March 9th, 2018
State Employees’ Credit Union (SECU) Scholarship Application
Student’s Name: __________________________________________________________ Social Security #: _____________________ (required)
Address: ______________________________________________________ City: ______________________ State: ________ Zip: ___________
Telephone #: ________________________________________________ NC Driver’s License #: ____________________________________
Email: __________________________________________________________________________________________________________________________
Race: ________________________________________________________ Gender: Male Female
Program Applied for: ______________________________________ County of Residence: _____________________________________
I qualify for this scholarship under the following criteria (please check all that apply):
I am currently unemployed. (Beginning date of unemployment: _____________________)
I am a military veteran.
I am a member of the NC National Guard.
I am working and earn wages at or below 200% of the federal poverty guidelines (see guidelines).
If you are qualifying under the criteria “working and earn wages at or below 200% of the federal poverty guidelines”,
please indicate the number of dependents living in your household that you are responsible for.
Number of dependents: __________ Ages: _______________________________
Explain in your own words why you should receive these funds:
I certify that I am NOT a director, employee or family member of an employee of the SECU or the SECU Foundation. ______
(Initial)
I he
reby verify that all the information given by me on this application form is complete and accurate to the best of my
knowledge.
___
_________________________________________________ _____________________ _____________________________
Signature Date
Work History
Have you worked in the past 12 months? No Yes If yes, complete the following:
Employer/Job Title
Start/End Date
Weeks
Employed
Hourly Wage
Hours Per
Week
Comments
2017-2018 SECU Underemployed Adult Guidelines
200% of the Federal Poverty Guidelines
SOURCE: Federal Register, Vol. 82, No. 19 January 31, 2017, pp. 8831-8832. Retrieved from
https://www.gpo.gov/fdsys/pkg/FR-2017-01-31/pdf/2017-02076.pdf
(Actual Guidelines on Federal Register listed at 100%)
Family
Unit
200% of
Poverty Guidelines
1
24,120.00
2
32,480.00
3
40,840.00
4
49,200.00
5
57,560.00
6
65,920.00
7
74,280.00
8
82,640.00
For each additional person, add $8,360.
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17 18 Secu Scholarship App (Johnston Community College)

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Completed 27 July 2020

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