Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587
Student Name: ____ __________________________________ NSCC ID number: N_______________________
Address: ___________________________________________ Home Phone Number: (_____)________________
City: _________________ State: _____ Zip Code: ____________ Cell Phone Number: (_____)______________
County: ____________________________ Email Address: ____________________________________________
Birthdate: __________________________
Projected NSCC Graduation Date: ______________________ I am attending: Full time Part-Time
I or a family member is employed at one of the following companies? Check all that apply
Arrow Tru-Line CK Technologies Automatic Feed Allied Moulded Spangler Candy
Name & relationship of family member:_______________________________ ** Your name and family members name will be shared with a company
representative to verify employment
I have an immediate family member that is a graduate of NSCC? Yes  No
Name of Graduate: _______________________________ Relationship (ex. Father): _____________________________
Last 4 digits of their SSN: ____________ Graduates date of birth ____________________
I or my spouse/parent(s) are a Veteran(s)? Yes No If yes, list relationship ________________________
I have filled out the 2020-2021 FAFSA? Yes No I am a member of PTK? Yes No
Describe how a scholarship will impact your educational goals?
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Describe your involvement/volunteering in your community or on campus.
______________________________________________________________________________________________
______________________________________________________________________________________________
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Share any information you would like the scholarship committee to know about you (i.e. financial, personal, educational, etc.).
______________________________________________________________________________________________
______________________________________________________________________________________________
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Information obtained through this application and from your student record will be shared with the scholarship committee in order to successfully determine scholarship
eligibility. By signing this form, I Certify that all the information reported is complete and correct. If selected as a scholarship recipient, I give permission for my name to be
shared in marketing materials and press releases.
Student Signature: __________________________________ Date:______________________
Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity, disability, religion or age in its programs or activities.
2020-2021
Scholarship Application
Henry County residents provide copy of unexpired state ID Office Use: Verify__________
Office Use: NSCC Verify_____________
Application is due in the NSCC Financial Aid Office by 4:00 pm on February 14, 2020
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587
Scholarships Needing Additional Documentation
Francis O. Fackler - Henry County Students
Eligibility: Student must be a current resident of Henry County and have a
minimum 2.5 cumulative GPA. Must provide a copy of an unexpired driver’s
license or State ID to verify Henry County address if mailing your application.
You must show the ID to the financial aid worker if bringing the application to
our office, and we will verify it for you.
PHI THETA KAPPA International Honor Society Scholarship
Eligibility: Any second year student (30 or more credits earned) maintaining
3.5 GPA or higher. Must be a member of PTK. In addition to the scholarship
application, students must submit a typed essay including personal,
academic and career goals, significant life experiences, accomplishments,
school and/or community activities and an explanation of your financial
need.
Allan Ohlrich
Students must submit a 300-500 word typed essay describing why they chose
a degree in Criminal Justice Law Enforcement Academy.