2017-2018 Educational Access and Diversity
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 Address *City *State *Zip Code *County of Residence
Mailing Address
(if different from above)
*Primary Phone Number Secondary Phone Number E-mail Address *Major
*Have you earned an associate degree or higher? Are you a previous recipient of the Educational Access and Diversity Scholarship at Northeast State?
*Do you consider yourself to be Hispanic / Latino / Spanish origin? *In addition, select one or more of the following racial categories to describe yourself:

Note: ethnicity criterion will be evaluated based on the categories documented by the Northeast State Office of Admissions and Records.
White
Black or African American
Asian
American Indian
Alaskan Native
Hawaiian / Other Pacific Islander
*Are you a United States military veteran?

Note: individuals applying for the Educational Access and Diversity Scholarship under the military veteran criterion who are not receiving Veterans Education Benefits and are not registered with the Office of Veterans Affairs must submit documentation proving veteran status. Please submit a copy of your government issued military I.D. card or DD Form 214 (Report of Separation) to the Office of Scholarship Programs and Student Needs (Room C2107 of the General Studies Building) on or before the June 1, 2017 deadline.
*Please submit a brief statement of need describing why you are applying for this scholarship and include any special circumstances or financial need you may have.
  
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 acknowledge that this scholarship award may be cancelled if I fail to meet the eligibility requirements. I certify that I have read and understand the guidelines for the Educational Access and Diversity Scholarship Program.
*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.