Community College Shady Grove Scholarship Application

Section A: Applicant Background Information

First Name

Middle Initial

Last Name


UMUC (EMPL) Student ID #

Date of Birth

Street Address



ZIP Code

Daytime Phone

E-mail Address

Do you have at least a 3.0 cumulative GPA?

Yes No

If yes, what is your cumulative GPA?

Are you on a visa?

Yes No

If yes, visa type:

Are you a current or previous student of Montgomery College?

Yes No

Degree Earned


Date of graduation or expected graduation

Are you currently participating in Reverse Transfer at UMUC?

Yes No

When do you plan to begin your studies?

Spring 2013 Fall 2013

Check one of the following:

I wish to be considered for a full-time scholarship. I will complete 30 credits per academic year.
I wish to be considered for a part-time scholarship. I will complete 15 credits per academic year.

Section B: Attach Supporting Documents

Attach a copy of your transcripts

Official Transcripts showing the attainment of your associates degree are required. Please have an official transcript sent to:

University of Maryland University College
Attn: Ashley Arvin
6865 Deerpath Road
Elkridge, MD 21075

Section C: Applicant Certification

By selecting "I Agree," I acknowledge that I have read and agree to the terms outlined in the certification and authorization agreement. Read the certification and authorization agreement.

Agree to Terms:

I Agree

Certification and Authorization Agreement

All of the information on this application is true and complete to the best of my knowledge. I certify that I meet all eligibility requirements as specified in this application. I understand that I may only receive one scholarship administered by UMUC per academic year. I hereby authorize UMUC to photograph me or utilize my likeness and information about my application for public relations purposes, publicity, or other scholarship opportunities. I agree to pursue and complete 15 credits (if I study part-time) or 30 credits (if I study full-time) and maintain a 3.0 GPA from UMUC in one academic year. I understand that if I do not complete these requirements the scholarship may be terminated. I am not currently receiving 100% tuition assistance from my employer at this time and I understand that my scholarship may be canceled if I receive 100% tuition benefits. I authorize UMUC to release personal information about me when requested by any donor or designee, my sponsoring community college, or any UMUC office for purposes relating to my scholarship application or any UMUC scholarship.