DSU
DEPENDENT STUDENT
SCHOLARSHIP APPLICATION
Name of Applicant: _______________________________DSU ID #____________________________
(do not use social security #)
Relationship to Employee__________________________ Contact Telephone Number______________
Employee_______________________________________ Number of Years at MDCC______________
Semester and Year Applying For: ____________________Number of Hours Applying For:__________
This application needs to be submitted 6 weeks before semester and year applying for
Student Date
Employee Date
Appropriate Supervisor Date
Associate Vice President / Vice President Date
President Date
After all signatures have been obtained, the President’s office will forward this form to Human Resources. HR will forward the
form to DSU.
Mississippi Delta Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. The
following person has been designated to handle inquiries regarding the non-discrimination policies: The Associate VP for Institutional Effectiveness, Boggs-
Scroggins Student Services Center, P.O. Box 668, Moorhead, MS 38761, 662-246-6558.
Updated 01/08/2019