2020/2021
Scholarship Application
REQUIRED Applicant Information
KCC Student ID Date of Birth Gender
Student Applicant
Legal Last Name Legal First Name Legal Middle Initial
Mailing Address
Street City State Zip
County Phone Personal email
Cell Home
Are you a rst generation college student? Yes No
Citizenship U.S. Citizen Non–U.S. Citizen Visa Type Country of Origin
Race/Ethnicity* Are you Hispanic or Latino? Yes No
Select one or more as appropriate: American Indian/Alaska Native Asian Black/African American
Native Hawaiian/Pacic Islander White Other _____________
*This information is optional and it is not used in application decisions.
Military Affiliation Active Member Veteran Spouse or Dependent of Active Member or Veteran
Were you honorably discharged from any branch of the military? Yes No
Will you be receiving 100% tuition-paying Veterans benets? Yes No
Have you been impacted by or in recovery from domestic violence, substance abuse, bullying, or human tracking?
Yes No
Do you have a diagnosis of ADHD, ADD or other learning disability? Yes No
Are you related to a KCC employee? Yes, if yes how No
Are you related to a KCC alum? Yes, if yes how No
Are you a KCC student athlete? Yes, if yes what sport? No
Have you received a KCC Foundation Scholarship in 2019/2020? Yes No
Your program of study/major
Be as specific as you can.
If "Undecided" or General Studies, what is your field of interest?
Have you been officially accepted in the Nursing/Allied Health program? Yes No
If yes, are you in the full-time or part-time program? FT PT Start Date
Month/Year
Have you been ocially accepted in KCC’s Police Academy? Yes No
Semester(s) you plan to attend:
Fall 2020 Spring 2021 Summer 2021
Number of credit hours Number of credit hours Number of credit hours
0-5 6-11 12+ 0-5 6-11 12+ 0-5 6-11 12+
What KCC campus do you plan to attend? (Check all that apply)
Battle Creek Campus Grahl Center Fehsenfeld Center Eastern Academic Center
Regional Manufacturing Technology Center
Complete one application only. Check all that apply:
Gold Key Board of Trustees General
Foundation
Scholarship Application (continued)
REQUIRED Academic Information
High school/Home school attended High School Diploma GED
Graduation or GED credential date
Year
Other schools/programs attended (ie. Career Center, Math & Science Center, FFA, 4-H)
If you attended a Career Center, what program were you enrolled in?
High School Cumulative GPA (must provide for Gold Key & Board of Trustees)
ACT or SAT composite score (must provide for Gold Key)
College(s) attended (including KCC) Year attended Cumulative GPA
Year attended Cumulative GPA
Degree(s) earned Year conferred
REQUIRED Employment Information
Are you employed? Yes No If yes, Full-time Part-time Hours per week
Employer Position
No work experience to date
REQUIRED Family/Household Information
Marital Status: Single Married Divorced Widowed
Are you a single parent? Yes No
Have you ever been in Foster Care? Yes No
Are you or were you an emancipated minor as determined by a court in your state of legal residence? Yes No
Will you be living with your parent(s) and/or legal guardian(s) in 2020/2021? Yes No
If yes, please list individuals in your family/household (excluding yourself):
Relationship Age Grade
Relationship Age Grade
Relationship Age Grade
Relationship Age Grade
Relationship Age Grade
Will you financially support yourself and/or your family in 2020/2021? Yes No
If yes, please list dependent children and/or other individuals you financially support:
Relationship Age Grade
Relationship Age Grade
Relationship Age Grade
Relationship Age Grade
Scholarship Application (continued)
REQUIRED
Financial Information
Have you applied for a 2020/2021 FAFSA? Yes No If yes, submit a copy of the Student Aid Report with this
application. If you have not completed the FAFSA and/or you do not have a Student Aid Report, you must complete the
following to be considered for a need-based scholarship. Use most recently filed tax form or estimated information.
For auditing purposes, the KCC Foundation may verify financial categories. Please be prepared to provide additional
documentation to support your information. If any information is discovered to be fraudulent, the KCC Foundation reserves the
right to revoke your scholarship award; you may be held liable for all tuition, fees, and book costs incurred.
If you were born before January 1, 2001 and/or you are married, you do not have to provide parental information.
Parent(s)/Guardian(s) Adjusted Gross Income 2019 (dependent students only) $
How much did your Father/Stepfather/Guardian earn from working in 2019 (dependent students only) $
How much did your Mother/Stepmother/Guardian earn from working in 2019 (dependent students only) $
Applicant's Adjusted Gross Income for 2019 $
Spouse's Adjusted Gross Income for 2019 (if applicable) $
Please explain any changes in family income/financial status:
The undersigned hereby acknowledges that the information provided on this application, including attachments, is true and cor-
rect to the best of their knowledge. I/we authorize the school to release academic information for the applicant. I/we understand
that this authorization may be provided to schools to obtain academic information. It is understood that the KCC Foundation
may release basic information about any scholarship award to outside parties for purpose of promotion/recognition.
Signature Date
Application Deadlines:
For Gold Key and Board of Trustees Scholarship March 2, 2020 by 5:00 pm
For General Scholarship March 9, 2020 by 5:00 pm
Faxed applications will not be considered.
Applications received or postmarked after this published deadline may not be considered.
Please return completed application and all documents by mail, email or in person to:
Kellogg Community College Foundation
Roll Building Room 301
450 North Avenue
Battle Creek, MI 49017-3397
kccfoundation@kellogg.edu
Scholarship Application (continued)
YOU MUST PROVIDE INFORMATION FOR ALL REQUIRED SECTIONS OF THIS APPLICATION.
YOU MUST ALSO SUBMIT ALL REQUIRED DOCUMENTATION
*
LISTED ABOVE. IF ANY
INFORMATION OR DOCUMENTS ARE MISSING, YOUR APPLICATION MAY NOT BE
CONSIDERED.
* Documents received cannot be released back to you at a later date. If you are submitting original documents, make copies first.
Scholarship Application Requirements
1. Submit a completed Scholarship Application. Answer each question to the best of your ability. Scholarship questions help
determine the KCC Foundation scholarships you may be eligible for and are based on criteria established by donors.
Include a copy of your Student Aid Report or complete financial information section.
Include a copy of DD Form 214, if you are a military veteran.
2. Submit an essay at least 150 words but no more than two pages addressing each of the following:
Why have you chosen your field of study and what led you to this decision?
What are your educational and career goals including what college(s) you plan to attend to after KCC?
Describe your leadership and/or volunteer experience and what you learned from it.
Why should we consider you for a scholarship?
3. a. Applicants graduating from high school in the year of this application must submit high school transcript and transcripts
from all colleges attended, including KCC.
Transcripts must be submitted with this scholarship application, even if you previously submitted them to the
KCC Foundation or any other KCC office.
All transcripts submitted can be unofficial.
b. All other applicants must submit a copy of KCC Placement Test scores and transcripts from all colleges attended,
including KCC.
Transcripts must be submitted with this scholarship application, even if you previously submitted them to the
KCC Foundation or any other KCC office.
All transcripts submitted can be unofficial.
4. Provide a copy of your ACT or SAT composite score, if available (required for Gold Key).
5. Attach a résumé of employment history, education, school and community service activities, volunteer experiences, honors, and
awards.
6. Enclose two signed current letters of recommendation from teachers/instructors, counselors/academic advisors, employers,
and/or community members.
Foundation
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome