Fillable Hopkinsville Community College - Academic Scholarship Application

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Hopkinsville Community College - Academic Scholarship Application

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Academic

Scholarship

Application

General Information

Hopkinsville Community College has a limited number of academic scholarships available for qualified students. These tuition

grants are in varying amounts. Tuition grants will be given to persons indicating evidence of ability to profit from college level

academic work. The academic scholarship selection committee will meet for the first time in early April. All applications

should be received by March 15 for consideration.

Scholarship Eligibility Procedure

Please read the following information carefully. Incomplete applications will not be considered.

All applicants for academic scholarships must:

1. Submit, or have on file, an application for admission to Hopkinsville Community College.

2. Determine with the college’s financial aid office eligibility of need-based aid. Submit the FAFSA including HCC’s school

code (001994).

3. Complete carefully all parts of this academic scholarship application.

4. Take the American College Test (ACT) (high school students only). Submit the ACT scores or placement test scores to

the admissions office.

5. Submit a copy of a high school transcript and college transcript if applicable. Official copy must be submitted to the

admissions office and a photocopy must be included with the scholarship application. Applicant must be a high school

graduate by the Fall semester of the current year.

6. A minimum 2.5 GPA (based on a 4.0 scale) is required.

7. Student must be enrolled at full-time status.

8. Have the appropriate school official complete the last part of this application (high school students only).

9. Return this application to: Scholarship Selection Committee/Financial Aid

Hopkinsville Community College

P. O. Box 2100

Hopkinsville, KY 42241-2100

For more information contact: Phone: (270) 707-3808 or Email: claire.bolinger@kctcs.edu

Consent for Release of Student Information

I hereby give my permission to the academic scholarship selection committee to publicly announce my award. If such

recognition involves reviewing my grade point average and scholastic record, the committee has my permission to use such

information. I also authorize the committee to share my application with any interested community club or organization for the

purpose of awarding scholarships. Further, I authorize use of my photo in promotion of college scholarships.

XXX - XX - ________

______-______-______

Social Security Number

________________________________________

Student’s Signature

Date

HCC STUDENT ID #: ___________________________

The academic scholarship committee reserves the right to reduce the amount of academic-based scholarship awards to

prevent possible “over awards” to students receiving need-based aid. The committee also reserves the right to reduce

awards based on hours enrolled.

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PLEASE COMPLETE ACCURATELY. This information may be used for news releases and publication articles.

Personal Information

Full Name: (last) (first) (middle) .

Male Female Date of Birth _____/_____/_____ Telephone ( ) - .

Home Address ______________________________________________________________________________________

Street, route, box no., etc City County State Zip Code

Family Information

List names as they should appear in news releases

Parent or Guardian Name ________________________________________________ Relationship __________________

Home Address (if different from student) ______________________________________ Living_______ Deceased _______

Place of Employment___________________________________________________________________________________

Parent or Guardian Name _________________________________________________Relationship __________________

Home Address (if different from student) ______________________________________ Living_______ Deceased _______

Place of Employment___________________________________________________________________________________

Parent or Guardian Name _________________________________________________Relationship __________________

Home Address (if different from student) ______________________________________ Living_______ Deceased _______

Place of Employment___________________________________________________________________________________

Spouse Name (if applicable) _______________________________________________ Living_______ Deceased _______

Home Address (if different from student) ___________________________________________________________________

Place of Employment___________________________________________________________________________________

College Plans

Planned date of entrance to HCC ______-______-______ If enrolled, number of credit hours completed ___________

Intended or declared major ____________________________________________________________________________

Intended profession or occupation _______________________________________________________________________

High School Educational Information

High School Attended ____________________________________________________ Graduation Date _____________

GED completion date (if applicable) ___________________________Hopkinsville or Cadiz Rotary Scholar? (circle one if

applicable)

List your most significant honors, awards, and extra curricular activities.

______________________________________________________________________________

____________________________________________________________________________

______________________________________________________________________________

Scholarship Applicant Statement

Please write an essay on the importance to you of the value of a college education and why you have chosen HCC.

(Attach a separate sheet, if needed.)

______________________________________________________________________________

Documentation of Community Service

Please describe in detail any community service and/or volunteer activities in which you have been directly involved.

(Attach a separate sheet, if needed.)

______________________________________________________________________________

Final Information and Signature

Check any that apply:

I am eligible for the Hopkinsville Rotary Scholars Program

I am eligible for the Cadiz Rotary Scholars Program

I am from Trigg County and participating in the Agriculture Technology Program

I am majoring in Agriculture or Economics

I am pursuing a nursing and/or allied health degree at HCC

I would like to be considered for the Pioneers, Inc. scholarship, which is directed to qualified students from

underserved, underrepresented populations in the HCC service area.

 I am a high school valedictorian or salutatorian.

 I plan to attend courses at the Fort Campbell extended campus.

 I am a sophomore (30 credit hours or more earned).

 I am a single parent.

 I am a GED graduate.

 I am a dual enrolled student (high school student taking college classes on HCC campus or extended campus.

 First generation college student (first in immediate family to attend college).

 I wish to be considered for the John T. Smith Scholarship Program that provides scholarships for African-American

Kentucky students. (Your ethnicity must match your Admissions application.)

Signature _________________________________________________________ Date ______-______-______

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To be filled in by the appropriate high school official after applicant has completed the previous sections (applicable only

to high school seniors). PLEASE INCLUDE HIGH SCHOOL AND COLLEGE TRANSCRIPTS.

Number in applicants graduating class ________ Applicant’s Rank ______ Applicant’s GPA _______ Scale Used _______

American College Test (ACT) standard score results (should be taken before the December testing date prior to enrolling).

English ________ Math ________ Reading ________ Science Reasoning ________ COMPOSITE _________

Additional Comments (optional)

______________________________________________________________________________

Date ______-______-______ Signature _____________________________________________

Position ______________________________________________

Please list the school officials to be notified, if scholarship is awarded

Name________________________________________ Position ______________________________________________

Address ____________________________________________________________________________________________

For Office Use Only

Amount Awarded $ _____________________ Date Awarded _______-______-______

Account number drawn from ___________________________________________________________________

Hopkinsville Community College is an institution of the Kentucky Community and Technical College System (KCTCS).

KCTCS does not discriminate based on race, color, religion, national origin, sex, disability,

or age in its programs and activities. The following person has been designated to handle

inquiries regarding non-discrimination policies: Dr. Alissa Young, P. O. Box 2100,

Hopkinsville, KY

42241-2100 or (270) 707-3705 www.kctcs.edu/student/code.htm

KCTCS is an equal opportunity employer and education institution.

Revised 01.30.2018

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