Community College Staff Scholarship Application

Section A: Applicant Background Information

First Name

Middle Initial

Last Name

Suffix

UMUC (EMPL) Student ID #

Date of Birth

Street Address

City

State

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:

Community college where you are employed

Degree Earned

Associate's Bachelor's Master's

Degree you are pursuing at UMUC

Bachelor's Master's Doctorate

When do you plan to begin your studies?

Spring 2013 Fall 2013

Section B: Attach Supporting Documents

Attach a copy of your transcripts

Attach verification of employment with an alliance community college

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 certify that I will not receive 100% tuition assistance from my employer while receiving this scholarship. 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 6 credits each fall and spring semester and a total of 12 credits from UMUC in one academic year and maintain a 3.0 GPA. I understand that if I do not complete these requirements the scholarship may be terminated. 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.