Updated 06/2019 - OSD
1. Last Name __________________________________________ First Name _______________________________ MI _____
2. Student ID # _________________________________
3. Date of Birth _________________________________
4. Address: __________________________________________________ City:_____________________________ State:____ Zip:_____________
5. Home Number _____________________________________________ Cell Number ________________________________________________
6. Employer (if applicable):_________________________________________________________________________________________________
Estimated Monthly Salary ______________________
7. Parent or Spouse’s Employer:_____________________________________________________________________________________________
Estimated Monthly Salary ______________________
8. Are you a citizen or a permanent resident of the United States? Yes No (circle one)
9. Are you a resident of the State of Missouri? Yes No (circle one)
10. Have you received a scholarship during previous semesters at East Central? Yes No (circle one)
If yes, please list names of scholarship and the semesters received.
__________________________________________________________________________________________________________________
11. Expected College Major: ________________________________________________________________________________________________
11. High School(s) Attended: _______________________________________________________________________________________________
12. Colleges Attended: _____________________________________________________________________________________________________
13. Civic, community and social activities, honors and offices held within the last two years (be specific): ___________________________________
_____________________________________________________________________________________________________________________
14. Briefly describe your academic and career goals along with any other information about yourself that would support your application:
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
15. Attach a short essay describing your academic and career goals along with any other information about yourself that would support your
application.
I hereby certify that the information submitted on this application is, to the best of my knowledge, correct. If I fail to meet the minimum academic
requirements, I understand that I will become ineligible for the award.
Signature ____________________________________________________________________________ Date ______________________
I hereby authorize the ECC Financial Aid Office to release information contained in my scholarship application to a third party. The sole
purpose of the release of this information is in connection with consideration by such third party of my eligibility for receipt of financial aid
in the form of a scholarship or other financial assistance. Such third parties include scholarship committees or individuals who need such
information in order to award financial assistance.
Signature ____________________________________________________________________________ Date ______________________
