Fillable Golden Leaf Scholarship Application

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Golden Leaf Scholarship Application

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  • 16 other fields

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U.S.A. forms for Caldwell Community College and Technical Institute

BROWSE CALDWELL COMMUNITY COLLEGE AND TECHNICAL INSTITUTE FORMS

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GOLDEN LEAF SCHOLARS PROGRAM
TWO-YEAR COLLEGES
2019-20
Curriculum Application Packet
The Golden LEAF Scholars Program – Two-Year Colleges will provide grants of up to $750
per semester, including summer term, for curriculum students and up to $250 per term for
occupational education students to assist with tuition, fees, books, supplies, childcare, and
transportation expenses and credential testing fees for mid-skill training courses. Community
colleges choose to participate in the program annually so eligible students must attend a
participating community college.
Student Eligibility Requirements
Eligible students must (1) demonstrate financial need and (2) reside in a rural county that is
tobacco dependent and/or economically distressed (Tier 1 or Tier 2 under the 3-Tier
designation). A scholarship recipient who resides in an eligible county upon initial award
will retain eligibility and will be eligible for renewal awards as long as the student’s place of
residence is within the state of North Carolina.
Eligible students may receive an award for each funded term. Financial aid offices will
determine their application procedures for receiving awards for subsequent terms. Selected
students will be required to disclose all financial aid awards as dictated by college financial aid
offices for award packaging. Golden LEAF Scholarships will not displace
governmental grants, e.g. Pell grants, for which the student may be eligible (may displace
loan funds).
Curriculum Students: Will be selected based on their financial need as reported in their
Free Application for Federal Student Aid (FAFSA). Degree seeking students must be
enrolled as a full-time student in order to receive the maximum scholarship awad. Grants for
less-than-full-time students will be prorated based on hours of enrollment and pending
availability of funds.
• Workforce Continuing Education Student Eligibility
o Students enrolling in Workforce Continuing Education (WCE) pathways/courses
offered for 96 hours or more and leading to a State or industry-recognized credential.
Eligible course codes are included on the attached Combined Course Library list.
o These pathways may consist of a single WCE course or a series of courses.
o Reside in North Carolina
o Eligibility criteria for students include:
• is unemployed;
• has received notification of a pending layoff;
• is working and is eligible for the Federal Earned Income Tax Credit
(FEITC); or
• is working and earning wages at or below two hundred percent (200%) of the
federal poverty guidelines.
o Students from underserved populations enrolling in pathways aligned with identified
workforce sectors. The underserved population would be identified by the college in
collaboration with sector employers (example: female students interested in training to be an
electrical line worker).
o Should a student become ineligible to use any semester’s scholarship award, those funds will
be awarded to other qualified students within the same institution.
o Students using funds for transportation purposes will be asked to sign a statement regarding
their travel to and from the college.
Student Selection Considerations
Applicants will be selected based on financial need and county of residence. Other selection
factors include:
The effect of the declining economy on his or her family.
Owner of or employed in farming/agriculture business
Owner of or employed in traditional industries (such as textile or furniture
manufacturing)
Household member lost their job or has gone from full-time to part-time
employment
Academic performance
Campus activities and community service
This program is funded by the Golden LEAF Foundation
North Carolina Community Colleges
Golden LEAF Scholars Program – Two-Year Colleges
2019-20 Curriculum
Student Application
Instructions: Complete this application and return the completed application to the college’s Financial
Aid Office. Occupational Education students must also submit a copy of their transcript with the
application.
Personal Information:
Full Name: _________________________________________________________________________
Social Security Number: _______________________________________________________________
Home Address: ______________________________________________________________________
City, State, Zip Code: __________________________________________________________________
E-Mail Address: ______________________________________________________________________
Phone Number: _____________________ Mobile number: ____________________
NC County of residence: _______________________________________________________________
Length of residence in county: ____ less than 5 years ____ 5 – 10 years ____ more than 10 years
(To be eligible for this scholarship, your permanent residence must be in an approved NC county.)
Educational Information:
College you are attending: _Caldwell Community College and Technical Institute
Curriculum Student _________ GPA ________ 1st semester _______ Not Enrolled
Program you are enrolled in: _____________________________________________________
Other Information:
Have members of your immediate family worked for or owned a farming or agricultural related business
now or in the past? ____ yes ____ no
Have you or members of your immediate family been employed in traditional industries such as furniture,
textiles, or tobacco manufacturing? ____ yes ____ no
Has anyone in your household lost their job in the past two years? ____ yes ____no
Has anyone in your household transitioned from a full-time job to a part-time job? ____ yes ____ no
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_______________________________________ ____________
_______________________________________ ____________
_______________________________________ ____________
Please list all campus and community service activities you are currently involved in.
Use of Funds:
____ Tuition ____ Fees ____ Books ____ Supplies ____ Credentialing Exams
____ *Childcare _____ *Transportation
(* Students using funds for childcare and/or transportation purposes are asked to sign the statement(s) below.)
Media Release
I hereby authorize Caldwell Community College and Technical Institute and the North Carolina Community
College System to share my name and address with one another and to release my name and address to the
Golden Leaf Foundation and the news media if I am awarded the Golden LEAF Scholarship.
I understand the Federal Educational Rights and Privacy Act of 1974 may prevent any disclosure of this
information if I chose not to execute this release.
I have read and understand the requirements for assistance. I hereby declare that the information provided on this
form is complete and correct to the best of my knowledge.
Applicant’s Signature Date
Use of childcare funds statement: If selected for funding from the Golden LEAF Scholars Program – Two-
Year Colleges, I certify that scholarship funds designated for childcare will be used exclusively while I am
attending class in order to fulfill my educational requirements.
Applicant’s Signature Date
Use of transportation funds statement: If selected for funding from the Golden LEAF Scholars Program –
Two-Year Colleges, I certify that scholarship funds designated for transportation will be used exclusively for the
purpose of supporting my travel to and from the college where I am enrolled for educational purposes.
Applicant’s Signature Date
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Golden Leaf Scholarship Application

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Completed 19 February 2020

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