Office of Student Financial Aid Office use only Code: WDSAPP / FA WD SEQUENCE AP
Phone: (240)567-5100
Workforce Development & Continuing Education
2019-2020 Sequence Scholarship Application
Please complete all sections of this form before printing it for submission.
Incomplete applications will NOT
be reviewed and all academic information will be verified.
Last Name:
First Name:
Date of Birth:
Street Address:
Zip Code:
Preferred Phone #:
Alternate Phone #:
Are you a Veteran or Military Dependent?
Yes: No:
Are you an employee of Montgomery College?
Yes: No:
SECTION B: Student Eligibility
B.1 Are you a current Maryland resident?
(check): Yes
B2. If you are not a current resident of Maryland, are you the graduate of a Maryland high school?(check):
If yes, submit an official high school transcript with this application.
B3. Are you an active duty member of the U.S. Military stationed, residing, or domiciled in Maryland?(check): YES NO
If yes, submit a copy of your active duty orders or DD214.
SECTION C: Sequence Scholarship Application Status at Other College(s)
Maryland requires that students may receive no more than $2,000 annually in an award year, for no more than two
workforce development sequence programs.
YES NOC1. Have you applied for a Maryland Workforce Development Sequence Scholarship at any other (check):
Maryland Community college?
C2. If your answer in 3a was “Yes”, please check the current status of your application(s): Pending Awarded Denied
C3. If the answer to 3a was “Yes”, please identify the college(s) to which you applied for funding:
College(s):____________________________ _____________________________ ___________________________
Note: If you exceed the allowed funding amount or number of program awards at MC and other colleges, you will be
financially responsible for all tuition, fees, and associated costs that are not eligible.
NO If you answered "NO", please complete the 2019-20
C4. Have you completed the 2019-20 FAFSA?
Please note: All official correspondence from the Office of Student Financial Aid (OSFA) will be sent to your
Montgomery College e-mail address.
Please write your MC email address: ______________________________
Office of Student Financial Aid Office use only Code: WDSAPP / FA WD SEQUENCE AP
Phone: (240)567-5100
SECTION D: Workforce Development Sequence Selection
Please indicate below the eligible workforce development sequence/program for which you wish to apply:
Some programs require application and acceptance into the program in order for you to qualify for the Sequence
Scholarship. Check the list on the website for details. Students may apply for up to two sequences, with a
maximum $2,000 total award for the award year. Please submit for one program at a time. Do not submit a second
application until your first application is awarded.
SECTION E: Drug-Free Pledge
I agree, as a condition of receiving the Maryland Higher Education Commission Scholarship, I pledge to
remain drug free for the full term of the award. Unlawful use of drugs and alcohol may endanger my enrollment
in a Maryland college, as well as my Maryland Financial aid award.
Student Signature: _______________________________________ Date: _________________________
SECTION F: Sequence Guidelines
Students must have a valid social security number and meet at least one of the Maryland
residency requirements listed under section C above. MC reserves the right to adjust or cancel your
scholarship at any time if it is determined that you do not meet the qualifications.
Scholarship recipients will be notified by college email.
Scholarship awards must be used in the current award year.
Scholarship funds can only be used to pay for tuition, fees, and associated costs of attendance
(books, equipment) for classes in eligible course series.
Students should not expect refunds of unused grant amounts. Scholarship funds not used within three
months of being awarded may be canceled and you will have to reapply.
Students must keep the college informed of any relevant name, address and phone number changes that
will affect our ability to contact you.
All scholarships are managed and awarded in accordance to the Maryland Higher Education
Commission’s prescribed guidelines and Montgomery College policy.
Submit completed form to the Office of Student Financial Aid at one of the addresses listed below.
SECTION G: Signature and Acknowledgement
By signing this application, I certify that all of the information provided in the application is true to the best of
my knowledge. I understand that Montgomery College reserves the right to adjust or cancel any scholarship
awards based on my failure to comply with the guidelines as listed, and I will be financially responsible for any
payments accrued as a result of any adjustments.
_________________________________ ______________________
Student Signature Date
Germantown Campus, 20200 Observation Drive, SA 110, Germantown, MD 20876 - Rockville Campus, 51 Mannakee Street, SV 124, Rockville, MD 20850
Takoma Park/Silver Spring, 7600 Takoma Avenue, ST 126, Takoma Park, MD 20912
Please specify your term of enrollment by checking the appropriate semester: Fall 2019 Spring 2020
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