2013-2014 Educational Access and Diversity Scholarship Application * required field

 

*Student Classification	*Last Name	*First Name	Middle Name or Maiden Name	*Student ID Number or the last 4 digits of your SSN
Select One Current Dual Enrolled or Fast Track Student Current Northeast State Student First-Time College Student Previous Northeast State Student Transfer Student Transient Student
*Street Address	*City	*State	*Zip Code	*County of Residence
		Select One TN NC VA Other		Select One Carter Johnson Sullivan Unicoi Washington Other
Mailing Address (if different from above)	*Home Phone Number	Cell Phone Number	E-mail Address	*Major
				Select One Certificate AAS AA AS Special Transient
*Have you earned an associate degree or higher?		Are you a previous recipient of the Educational Access and Diversity Scholarship at Northeast State?
Select One No Yes		Select One No Yes

*Do you consider yourself to be Hispanic / Latino / Spanish origin?			*In addition, select one or more of the following racial categories to describe yourself:
Select One No Yes 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?
Select One No Yes 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 (Room F100 of the Faculty Office Building) on or before the July 1, 2013 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.