Fillable 2020-21 Student Data & Consent Form College: Wilson (Wilson Community College)

Fill Online, Printable, Fillable, Blank 2020-21 Student Data & Consent Form College: Wilson (Wilson Community College) Form

Use Fill to complete blank online WILSON COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

2020-21 Student Data & Consent Form College: Wilson (Wilson Community College)

On average this form takes 6 minutes to complete

The 2020-21 Student Data & Consent Form College: Wilson (Wilson Community College) form is 1 page long and contains:

  • 0 signatures
  • 16 check-boxes
  • 17 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Wilson Community College

BROWSE WILSON COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
2020-21 Student
Data & Consent Form
College: Wilson Community College
Full Name of Scholarship Recipient
Address
Phone
E-Mail
Target Group Affiliation (Check all that apply)
Gender
⃣
Unemployed /
Underemployed* Adult
NC National
Guard Member
Military Veteran
or Spouse
Underserved Populations: Specific
Workforce Sector or Area
⃣
Female
⃣
Male
Current Employment
Status
Ethnicity
⃣
Unemployed
African American
Hawaiian/Pacific Islander
Non-Hispanic/Latino
⃣
Underemployed*
American/Alaskan Native
Hispanic/Latino
White/Caucasian
⃣
Employed Full-Time
Asian
* Underemployed is defined as individuals earning within 200% of the federal poverty level guidelines or below.
Award Information
Award Date
Scholarship Eligible Course
Associated Credential(s)
How would you have funded the course(s) if you
had not received the scholarship?
Do you plan to enroll in further training?
If yes, what future training do you plan to seek?
*College should see SECU Foundation Bridge to Career Program Guidelines for course eligibility requirements.
Please attach the following documents:
⎯ Student Bio – Should detail the student’s need for the scholarship and how it will help with their
educational and vocational goals.
⎯ Student Photo
Student Consent
As a condition of the award, I give my consent to the release of my name, biographical statement, and image for
publications written/distributed by the System Office, the local Community College, and/or the State Employees’
Credit Union and its Foundation. As condition of this award, it is my responsibility to notify the College of licensure,
certification and/or job obtainment because of participation in this program. I further consent to be contacted after
completion of my coursework to determine if my participation in the program assisted me in gaining certification
and/or employment.
I attest I am not an employee, Board Member, or family member of the State Employees’ Credit Union or SECU
Foundation.
Student Signature:
Name
Phone
E-Mail
College
Scholarship Coordinator:
Lois McNeal
(252) 246-1287
lmcneal@wilsoncc.edu
Updated: April 29, 2019
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

2020-21 Student Data & Consent Form College: Wilson (Wilson Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document