2017-2018 Online General Scholarship Application
* required field
*Student Classification *Last Name *First Name *Middle Name or Maiden Name Northeast State Student ID Number
or the last 4 digits of your SSN
*Street or Mailing Address *City *State *Zip Code *County
*Primary Phone Number Secondary Phone Number *E-mail Address *Date of Birth (MM/DD/YYYY) Gender
Male Female
Are you a first-generation college student?
You are not a first-generation college student if either your mother or your father graduated from college with a bachelor's degree or higher.
Do you consider yourself to be Hispanic / Latino / Spanish origin? In addition, select one or more of the following racial categories to describe yourself:
Black or African American
American Indian
Alaskan Native
Native Hawaiian / Other Pacific Islander
Are you a US Citizen? High School Attended Graduation Year (YYYY) Cumulative High School GPA
GED Battery Average Score GED Total Score HiSET Score Best ACT Composite Score Best SAT Critical Reading + Math Score
While in high school, did you participate in a college enrichment program? Select one or more of the programs in which you participated:
Advanced Placement
Articulated Credit
College Access Program
Joint Enrollment
Jump Start or Dual Enrollment
*Previous College Credit If yes, list college(s). Cumulative College GPA Earned Hours
Yes No
*Previous College Graduate If yes, select highest degree earned. *Planned Enrollment at Northeast State *Intended Degree Program at Northeast State
Yes No
*Intended Major at Northeast State
Are you an employee or a dependent child of a current employee of one of the companies below? If yes, select all that apply.
AGC Flat Glass North America, Inc.
BAE Systems Ordnance Systems, Inc.
Brock Services, Ltd.
City of Kingsport
Industrial Electronics Services, Inc.
Kingsport Publishing Corporation
North American Corporation
Regions Bank
Triad Packaging Company
Wellmont Health System
Are you a participant in one or more of the following Northeast State programs? If yes, select all that apply. Alpha Sigma Lambda
Argumentation and Debate Society
Honors Program
Next Step Accelerated Studies
Northeast State Singers
Phi Theta Kappa
TRiO Student Support Services
Please list other extracurricular activities. Please list awards and honors received.
Have you completed significant community service during the past year? Yes No
If yes, please list community service activities and the number of hours volunteered.
Please enter the total number of hours volunteered.
Have you directly benefited from services provided by Shriners Hospitals for Children? Yes No Are you a United States Military Veteran? Yes No
*In a brief essay, please describe your need for a scholarship, short-term and long-term career goals, and why you selected Northeast State as your college of choice.
Please Read Carefully Before Submitting the Scholarship Application:

I certify that the information on this application is true and complete to the best of my knowledge. I have read and understand the Scholarship Categories and Provisions that apply to the Northeast State Scholarships. I understand that any award of any scholarship is tentative and contingent upon subsequent funding and actual funds by the Northeast State Foundation and any other scholarship program sponsor applicable to this application. I understand that the College reserves the right on behalf of the Northeast State Foundation or other program sponsor to amend or cancel awards because of restrictions mandated by the Foundation or other program sponsor.
*Electronic Signature (Please type in your name to certify this application.)

Please review the information on your application before clicking the "submit" button.
You will NOT be able to make any changes to your application after submission.