Fillable Student Data Form Tobacco Trust Fund Commission Project (Johnston Community College)

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Student Data Form Tobacco Trust Fund Commission Project (Johnston Community College)

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Updated: May 18, 2018
Tobacco Trust Fund Commission – Project Skill Up
Workforce Continuing Education Scholarship Program
Student Data Form
2018-2019
College:
Johnston Community College
Full Name of Scholarship Recipient
Address
Phone
E-Mail
Target Group Affiliation (Circle/Bold all applicable)
Former Tobacco
Quota Holder
Current/Former
Tobacco Farmers
Current/Former
Employee of Tobacco
Related Industry
Currently Engaged in
Agricultural Related
Activities
Unemployment
Insurance Claimant
Unemployed/
Underemployed* Adult
NC National Guard
Member
Military Veteran
or Spouse
* Underemployed is defined as individuals earning within 200% of the federal poverty level or below.
Award Information
Class Start
Date
Training Program
*include all course sections related to
training program
Associated Credential(s)
Please attach the following documents:
Student Bio that includes comments on the student’s need for the scholarship. Include any
relevant information aligned with TTFC focused criteria
Student Photo
Student Consent
As a condition of the award, I give my consent to the release of my name, biographical statement, and
image for publications written/distributed by the System Office, the local Community College, and/or the
Tobacco Trust Fund Commission. I understand that I will be contacted after completion of my coursework
to determine if my participation in the program assisted me in gaining employment.
Student Signature:
COLLEGE USE:
Name Phone E-Mail
PSU Scholarship Coordinator:
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Student Data Form Tobacco Trust Fund Commission Project (Johnston Community College)

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Completed 26 July 2020

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