2021-2022 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 Social Security Number
Select One Current Dual Enrolled Student Current Northeast State Student First-Time College Student Previous Northeast State Student Transfer Student Transient Student
*Street or Mailing Address	*City	*State	*Zip Code	*County
		Select One TN NC VA Other		Select One Avery Carter Claiborne Cocke Grainger Greene Hamblen Hancock Hawkins Jefferson Johnson Mitchell Russell Scott Sevier Sullivan Unicoi Union Washington, TN Washington, VA Watauga Other
*Primary Phone Number	Secondary Phone Number		*E-mail Address	*Date of Birth (MM/DD/YYYY)
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.			Are you a US Citizen?
Select One Yes No			Select One Yes No
Do you consider yourself to be Hispanic/Latino/Spanish origin?			Gender
Select One Yes No			Select One Female Male
In addition, select one or more of the following racial categories to describe yourself:			White Black or African American Asian American Indian Alaskan Native Native Hawaiian or Other Pacific Islander

 

High School Equivalency Test Score (GED, HiSET, etc.)	High School Attended		High School Graduation Month/Year (MM/YY)	Cumulative High School GPA
	Select One High School Equivalency Diploma (GED, HiSET, etc.) Abingdon High School Academy at King American School Appalachian Christian School Asbury Optional High School Avery County High School Calvary Life Academy Cedar View Christian School Cherokee Comprehensive High School Christian Life Academy Chuckey-Doak High School Cloudland High School Daniel Boone High School David Crockett High School Dobyns-Bennett High School Elizabethton High School Family Christian Academy Gate City High School Gateway Christian Schools Gravely Apostolic Christian School Greeneville High School Hampton High School Happy Valley High School Holston High School Homelife Academy Homeschool John S. Battle High School Johnson County High School Lighthouse Christian School Mitchell High School New Hope Academy New System School North Greene High School Patrick Henry High School Providence Academy Rye Cove High School Science Hill High School South Greene High School Sullivan Central High School Sullivan East High School Sullivan North High School Sullivan South High School Tennessee Avenue Christian Academy Tennessee High School Tri-Cities Christian School Twin Springs High School Unaka High School Unicoi County High School University School Virginia High School Volunteer Comprehensive High School Watauga High School West Greene High School Other
*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	Select One Certificate Associate Bachelor's Master's Doctorate Other	Select One Full-Time (12+ credit hours) 9-11 credit hours 6-8 credit hours 1-5 credit hours	Select One Certificate Associate Degree
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. Name of Employee   _____________________________________________________________ BAE Systems Ordnance Systems, Inc. Name of Employee   _____________________________________________________________ Ballad Health Name of Employee   _____________________________________________________________ Brock Services, Ltd. Name of Employee   _____________________________________________________________ Citi Name of Employee   _____________________________________________________________ City of Kingsport Name of Employee			Domtar Name of Employee   _____________________________________________________________ Industrial Electronics Services, Inc. Name of Employee   _____________________________________________________________ Kingsport Publishing Corporation Name of Employee   _____________________________________________________________ North American Corporation Name of Employee   _____________________________________________________________ Regions Bank Name of Employee   _____________________________________________________________ Triad Packaging Company Name of Employee
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
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.
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? 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.

Please Read Carefully Before Submitting the Scholarship Application: I certify that the information on this application is true and correct to the best of my knowledge. I have read and understand the Scholarship Categories and Provisions that apply to 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. I agree that any pertinent directory information supplied on this application can be released to the media if I am selected as a recipient of a Northeast State Scholarship. I authorize Northeast State Community College to share any pertinent academic and financial aid information with the Northeast State Foundation and the Scholarship Selection Committee. This information will be used exclusively to determine my eligibility for Northeast State Scholarships. *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.