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
*Street or Mailing Address *City *State *Zip Code *County
*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?
Do you consider yourself to be Hispanic/Latino/Spanish origin? Gender
In addition, select one or more of the following racial categories to describe yourself: White
Black or African American
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
*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
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.


City of Kingsport


Industrial Electronics Services, Inc.

Kingsport Publishing Corporation

North American Corporation

Regions Bank

Triad Packaging Company
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.