High School Equivalency Test Score (GED, HiSET, etc.) |
High School Attended |
High School Graduation Month/Year (MM/YY) |
Cumulative High School GPA |
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*Previous College Credit |
If yes, list college(s). |
Cumulative College GPA |
Earned Hours |
Yes
No |
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*Previous College Graduate |
If yes, select highest degree earned. |
*Planned Enrollment at Northeast State |
*Intended Degree Program at Northeast State |
Yes
No |
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Are you an employee or a dependent child of a current employee of one of the companies below? If yes, select all that apply and list the name of the employee. |
AGC Flat Glass North America, Inc.
_____________________________________________________________
BAE Systems Ordnance Systems, Inc.
_____________________________________________________________
Ballad Health
_____________________________________________________________
Brock Services, Ltd.
_____________________________________________________________
Citi
_____________________________________________________________
City of Kingsport
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Domtar
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Industrial Electronics Services, Inc.
_____________________________________________________________
Kingsport Publishing Corporation
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North American Corporation
_____________________________________________________________
Regions Bank
_____________________________________________________________
Triad Packaging Company
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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
Northeast State Singers
Phi Theta Kappa
TRiO Student Support Services
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Please list other extracurricular activities. |
Please list awards and honors received. |
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Have you completed significant community service during the past year? |
Yes
No |
If yes, please list community service activities. |
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Please enter the total number of hours volunteered. |
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Have you directly benefited from services provided by Shriners Hospitals for Children? |
Yes
No |
Are you a United States Military Veteran?
Are you a dependent (child 26 years of age or younger or spouse) of a United States Military Veteran or Service Member? |
Yes
No
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. |
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