HUDSON VALLEY COMMUNITY COLLEGE SCHOLARSHIP APPLICATION
FOR STUDENTS ENROLLED IN THE COLLEGE IN THE HIGH SCHOOL
To receive consideration, all applications must be signed by a high school official certifying eligibility of the student.
Name: _______________________________________________________________________________________________________________
Address: _____________________________________________________________________________________________________________
Street Address Village/Town/City
_____________________________________________________________________________________________________________
State Zip County
E-Mail: ______________________________________________ Telephone Number: ______________________________________________
SSN: ______________________________________________________________________________________________________________
Applicant’s Signature: ____________________________________________________________________ Date: _________________________
High School Attending: _________________________________________________________________________________________________
I understand that the Foundation Scholarship Committee and donors may review my academic records in order to determine my eligibility for scholarships, including my Grade Point
Average, Federal Application for Student Aid and, in the case of international students, a Financial Needs Assessment form which should be completed and filed with the Financial
Aid Office. I hereby authorize the review of these records for such purposes. Unless I have a FERPA hold on file with the college, I understand and give my consent to the following:
• Listing the criteria and non-directory information about me that has made me eligible for this scholarship in any articles, press releases or other publications about
Hudson Valley Community College or the Foundation and the scholarship award.
• The use of my picture in such articles, press releases or other publications.
By submitting this application, I verify that the information provided is true and accurate. I understand that Foundation policy states that students found to have falsified information
on their application will lose their eligibility.
HIGH SCHOOL STUDENTS:
Applications must be received no later than:
October 28, 2020
If hand-delivered, scholarship applications must be received by 5 p.m. on the day they are due. Incomplete applications will not be considered.
SCHOLARSHIP APPLICATIONS MUST BE EMAILED OR DELIVERED TO:
Hudson Valley Community College
Guenther Enrollment Services Center, Suite 252
Attention: MaryKate Kraus
80 Vandenburgh Avenue, Troy, New York 12180-6096
cihs@hvcc.edu
Signature of Official Certifying Eligibility Date
for Federal Free Lunch Program
Print Name/Title
SCHOLARSHIP DEADLINES
Hudson Valley Community College does not discriminate on the basis of age,
gender, race or ethnicity, national origin, religion, disabling condition, marital
status or sexual orientation. If you have a disability and require any reasonable
accommodations, or an interpreter, please contact the Center for Access
and Assistive Technology at (518) 629-7154 or TDD (518) 629-7596.
A State University of New York college
Sponsored by Rensselaer County
Tobacco-free college
IMPORTANT NOTE: Hudson Valley Community College is required by federal law/regulations to collect your Social Security Number (SSN) or Individual Taxpayer Identification
Number (ITIN) to file information returns with the IRS and to furnish a statement to you. In addition, your name on file with the college must match your name as filed with the
Social Security Administration. If you fail to furnish your correct SSN or ITIN to the college, you may be subject to a penalty levied by the IRS.
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