APPLICATION DEADLINE: FRIDAY, MARCH 3, 2017 5:00 pm

SCHOLARSHIP APPLICATION – NONTRADITIONAL STUDENTS NAME:

PHONE NUMBER:

MAILING ADDRESS: (Address)

(City, State, Zip)

EMAIL ADDRESS: MAIDEN NAME IF DIFFERENT FROM ABOVE: Are you a member of Lumbee River EMC? YES

NO

(Applicant must be a member of Lumbee River EMC to be eligible for scholarship)

NAME OF SCHOOL WHERE APPLICANT RECEIVED HIGH SCHOOL DIPLOMA OR GED:

SCHOOL ADDRESS: (Address)

(City, State, Zip)

SCHOOL TELEPHONE NUMBER: WHICH ACCREDITTED COMMMUNITY COLLEGE/TECHNICAL SCHOOL(S) HAVE YOU APPLIED TO? SCHOOL

LOCATION (CITY, STATE)

WHAT WILL YOUR COURSE OF STUDY/MAJOR BE?

HAVE YOU BEEN ACCEPTED

ACADEMICS

APPLICATION DEADLINE: FRIDAY, MARCH 3, 2017 5:00 pm

Attach proof of graduation from an accredited high school or proof of GED Attach proof of any Continuing Education Units (CEUs) applicant has received post high school.

PERSONAL STATEMENT Write about why you are seeking this scholarship and how your school/community/work activities have influenced your goals and career choice. This statement should be no more than two double-spaced typed pages.

LETTERS OF PERSONAL RECOMMENDATION Attach two (2) letters of recommendation. These recommendations can be from an employer, educator or leader with the community where you have been involved.

WORK EXPERIENCE AND ACTIVITIES WORK EXPERIENCE ORGANIZATION/COMPANY

NUMBER OF YEARS

POSITION OR DESCRIPTION OF WORK

PERSONAL ACHIEVEMENT(S)/COMMUNITY INVOLVEMENT: Give years or membership, offices held and/or honor received. (Non-work related activities including church, civic and community) ACTIVITY

NUMBER OF YEARS

OFFICE(S)/HONOR(S) HELD

NEED

APPLICATION DEADLINE: FRIDAY, MARCH 3, 2017 5:00 pm

Have you received a full tuition scholarship to the school of your choice? YES

NO

Are you receiving additional financial assistance from other avenues such as former/current employer? YES NO If yes, what amount? Personal adjusted gross income:

(From previous years, Federal Income Tax Form)

Other Income (source & amount):

(Social Security, Disability, Child Support, etc.)

The following individuals are supported in my household. I have noted their contribution to our family income. NAME & AGE PLACE OF EMPLOYMENT INCOME AMOUNT

STATEMENT OF APPLICANT I have included all items requested and answered all questions. I understand that incomplete applications will not be considered, and that all financial and family information in this application will be held in strict confidence by cooperative employees and program judges. I have examined this application and the information is true, complete and accurate to the best of my knowledge. (Applicant signature here)

(Date)

Submit Completed Application and Documentation to: Lumbee River EMC Youth Programs PO Box 830, Red Springs, NC 28377 or via email to [email protected]

APPLICATION DEADLINE: FRIDAY, MARCH 3, 2017 5:00 pm

STATEMENT OF FORFEITURE I,

, understand that at any time during the tenure of my (print applicant name here) college attendance, should I discontinue attendance at an accredited

institution, I will forfeit any and all of the remaining scholarship funds that I may have previously been entitled to receive.

(Applicant signature here)

(Date)

APPLICATION DEADLINE: FRIDAY, MARCH 3, 2017 5:00 pm APPLICATION JUDGING & GUIDELINES Judging for scholarships will be based on: 1. Work Experience

25 %

2. Community Activities

25 %

3. Need

25 %

4. Personal Statement

25%

You must include the following with your application: 1. Personal statement: Write about why you are seeking this scholarship and how your school/community/work activities have influenced your goals and career choice. This statement should be no more than two double-spaced typed pages. 2. Proof of high school graduation or GED completion. 3. Letter(s) of personal recommendation. 4. Letter of acceptance from an accredited an accredited community college or technical school you plan to attend in the fall.