Fillable North Carolina Community Colleges Governors Emergency Education Relief (South Piedmont Community College)

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North Carolina Community Colleges Governors Emergency Education Relief (South Piedmont Community College)

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Country of origin: US
File type: PDF

U.S.A. forms for South Piedmont Community College

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North Carolina Community Colleges
Governor’s Emergency Education Relief
(GEER)
2020-2021 Student Application
Instructions: Complete this application and return the completed application to South Piedmont
Community College’s Financial Aid Office.
Personal Information:
Full Name: __________________________________________________________________
Home Address: _______________________________________________________________
City, State, Zip Code: __________________________________________________________
E-Mail Address: _______________________________________________________________
Phone Number: _____________________
Educational Information:
College you are attending: _South Piedmont Community College_________________________
Occupational Continuing Education Student (must be enrolled in a credentialing program of at
least 96 hours.)
Select the Pathway you are enrolled in:
Automotive Healthcare
Industrial/Manufacturing Therapeutic Massage
Construction Information Technology
Criminal Justice Transportation
Emergency Medical Services Fire and Rescue Services
Course you are enrolled in: _____________________________________________________
Course Start Date: _______________________
Other Questions:
Have you or members of your family been directly or indirectly affected by COVID-19?
____ yes ____ no
If yes, how?
____________________________________________________________________________
____________________________________________________________________________
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
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signature
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Scholarship Program Photograph and Publicity Release Form
I, ______________________________, hereby give my college, the North Carolina Community
College System (NCCCS) and scholarship donor, permission to use my name, likeness, image,
voice, and/or appearance as such may be embodied in any pictures, photos, video recordings,
audiotapes, digital images, and the like, taken or made on behalf of the donor’s activities. I
agree that the NCCCS has complete ownership of such pictures, etc., including the entire
copyright, and may use them for any purpose consistent with the organization’s education
missions. These uses include, but are not limited to illustrations, bulletins, exhibitions,
videotapes, reprints, reproductions, publications, advertisements, and any promotional or
educational materials in any medium now known or later developed, including the Internet.
I acknowledge that I will not receive any compensation for the use of such pictures, etc., and
hereby release the NCCCCS, scholarship donor and its agents and assigns from any and all
claims which arise out of or are in any way connected with such use.
I have read and understood this consent and release.
I give my consent to the North Carolina Community College System (NCCCS) and scholarship
donor to use my name and likeness to promote the Scholarship program, education, and/or their
activities.
___________________________________________ __________________
Signature Date
___________________________________________ ___________________
Parent/Legal guardian (if age 17) Date
I do not give my consent to the North Carolina Community College System (NCCCS) and
scholarship donor to use my name and likeness to promote the Scholarship program, and/or
their activities.
___________________________________________ __________________
Signature Date
___________________________________________ ___________________
Parent/Legal guardian (if age 17) Date
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North Carolina Community Colleges Governors Emergency Education Relief (South Piedmont Community College)

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Completed 3 February 2021

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