ApplicantName
Address
EmailAddress
Phonenumber CountyofResidence
Areyoucu
rrentlyenrolledatBevillStateCommunityCollege? Yes No
HaveyoucompletedtheFreeApplicationforFederalStudentAid(FAFSA)? Yes No
Pleaseselectyourpreferredlocation:
FayetteCampus HamiltonCampus JasperCampus SumitonCampus
PickensCountyEducationalCenter(Carrollton)
Areyoucurrentlyemployed? Yes No
IfYes,whoisyourcurrentempl
oyer?
Willyouremployerbepayingyourtuition? Yes No
IfNo,haveyourecentlylostorleftyourjob? Yes No
IfYes,whichoneofthesereasonsbestdescribe s whyyouarecurrentlyunemployed:
Myformeremployerclosedorchangedlocations
Therewasnoten
oughworkforme
Myemployereliminatedmypositionorshift
Other
ApplicantswillberequiredtosubmitanEmployeeVerificationFormtoconfirmthisinformation
WhatwillbeyourprogramofstudyatBevillState?
Spring 2021 Community Scholarship Application
ForBevillStateUseOnly:
CurrentlyEmployed Lostorleftjob Notcurrentlyenrolled Meetpre‐requisites
FiledFAFSA In‐Statetuition Otherfundsapplied Registerforsixhours
Employmentverificationdatereceived
Applicationdatereceived