COCC Youth Program Scholarship
Scholarship Criteria & Application Form
Award criteria specifies that the recipient:
1. is a
resident of the Central Oregon Community College district (scholarships granted only to in-district
students).
2. will demonstrate a desire to attend a youth program by writing a short paragraph of why they want to
attend. Attach to the scholarship application or write on the back of this form. This may be hand or type
written, but must be legible and written by the participant.
3. has a parent/guardian or responsible adult who will sign the agreement at the bottom of the application
form to oversee the remote access or provide transportation to attend the program.
4. has a verifiable financial need (a child whose family qualifies for free or reduced price lunch, whose family
receives SNAP or TANF, or a child who is in foster care or out-of-home care, or a child who is homeless). Or,
that the parent provides an explanation of a temporary financial hardship (loss of job, medical hardship,
etc.)
5. will only be registered for one program or camp and considered for one scholarship per quarter.
6. will remit remaining program costs at time of registration – scholarship will cover 1/2
Student Name ____________________________________________DOB (required) _________________________
Address ________________________________________________________________________________________
_______________________________________________________________________________________________
Parent/Guardian Name ___________________________________________________________________________
Address (if different from student) __________________________________________________________________
_______________________________________________________________________________________________
Daytime Phone Number __________________________ Email ___________________________________________
Student or Family verifiable financial need (check all that apply):
o SNAP
o TANF
o Free or Reduced Lunch
o Student in Foster Care or Out of Home Care
o Homeless
o Temporary financial hardship – please explain
I agr
ee to ensure that this student (print name) _________________________________________ has remote access (online
classes) or transportation (in-person classes) or a means to attend each program session.
________
________________________________ ____________________________________________________________
Parent/Guardian Signature Printed Name of Parent/Guardian & Phone Number
Return form & required documents to COCC Continuing Education:
1) Scan & email to: ceinfo@cocc.edu
2) By Mail to COCC Continuing Education - 2600 NW College Way, Bend, OR 97703
3) By Fax to 541.383.7503
Scholarship Application Materials will be r
eviewed by the Youth Program Scholarship Committee and the applicant will
be notified within 2 weeks. If applicant is not granted a scholarship, the applicant will be liable for the full amount of
the registration fee or will forfeit their registration 7 business days prior to the start of the program.
COCC Conti
nuing Education
• 2600 NW College Way • Bend OR 97703 • 541 383 7270 • cocc.edu/ContinuingEd
