Scholarship Application Requirements

KEMPER COUNTY SCHOLARSHIP FOR EAST MISSISSIPPI COMMUNITY COLLEGE

SCHOLARSHIP APPLICATION REQUIREMENTS

Student Eligibility:

Scholarship funds can only be used towards tuition, books, lab fees, and/or housing. To qualify for the scholarship the student must comply with the following criteria:

1. Be on track to graduate in 2016 from either a public or private high schoolin Kemper Co.,or homeschool
2. Student must enroll as a full-time student at East Mississippi Community College (EMCC)
3. Student must have a Grade Point Average (GPA) not less than2.5 (on a 4.0 scale)
4. Student must have an ACT score not less than 18
5. Participation in extracurricular activities is preferred
6. Participation in community civic activities is preferred
7. Participation in a leadership program is preferred

In order to apply for the scholarship, students may submit a completed application package to theirhigh school Counselor/Advisorno later than Wednesday, May 11, 2016. Completed applications may also be emailed to the Community Foundation of East Mississippi (see email address below) no later than midnight Wednesday, May 11.

Completed application packets must include the following items:

1. Fully completed and signed application
2. Copy of high school transcript and/or most recent report card
3. Copy of ACT score
4. List of all school-based and/or community-based activities, and leadership program(s)

KEMPER COUNTY SCHOLARSHIP FOR EAST MISSISSIPPI COMMUNITY COLLEGE
SCHOLARSHIP APPLICATION

2016Cover Page/Student Information

Please attach this form to your completed application, provideyour high school Counselor/Advisor a hard copy or email your completed application to the Community Foundation of East MS (address below). All completed scholarship applications must be either turned into your high school counselor or emailed to the Community Foundation of East Mississippi no later than Wednesday,May 11, 2016. Any application received after May 11, 2016, will not be accepted.

1. Turn this completed application and necessary documents to your high school counselor

OR

2. Email completed application and necessary documents to:

STUDENT INFORMATION:

NAME: ______
ADDRESS: ______

CITY: ______STATE: ______ZIP: ______
PHONE NUMBER: ______

EMAIL ADDRESS: ______

DATE OF BIRTH: ______GENDER: ______AGE: ______

Please tell us your preferred method of communication: email____ phone____ mail____

PARENT/GUARDIAN INFORMATION

NAME: ______
ADDRESS: ______

CITY: ______STATE: ______ZIP: ______
PHONE NUMBER(s): ______

EMAIL ADDRESS: ______

I HAVE PARTICIPATED IN THE FOLLOWING ACTIVITIES DURING MY HIGH SCHOOL YEARS:

ACTIVITIES:YEARS / TIME FRAME:

______

______

______

______

I HAVE PARTICIPATED IN THE FOLLOWING COMMUNITY CIVIC ACTIVITIES DURING MY HIGH SCHOOL YEARS:

ACTIVITIES:YEARS / TIME FRAME:

______

______

______

______

I HAVE PARTICIPATED IN THE FOLLOWING LEADERSHIP PROGRAMS DURING MY HIGH SCHOOL YEARS:

ACTIVITIES:YEARS / TIME FRAME:

______

______

______

______

(Attach additional page if needed)

HIGH SCHOOL INFORMATION:

HIGHSCHOOL: ______
SCHOOL ADDRESS: ______

GPA: ______(4.0 Scale)ACT Score: ______

I QUALIFIED FOR THE ACT FEE WAIVER: Yes ______or No ______(Please check one)

CHECK ONE OF THE FOLLOWING:

I HAVE APPLIED TO ENROLL AS A FULL-TIME STUDENT AT EMCC: ______

or

I HAVE BEEN ACCEPTED AS A FULL-TIME STUDENT AT EMCC: ______

MY ANTICIPATED MAJOR IS: ______

STUDENT NAME: ______(Please Print)

STUDENT SIGNATURE: ______
DATE: ______

PARENT/GUARDIAN’S NAME: ______(Please Print)
PARENT/GUARDIAN’S SIGNATURE (required):______

DATE: ______

ADDITIONAL SCHOLARSHIP INFORMATION:

Name and amounts of any scholarships / financial aid you expect to receive or have been notified of as being awarded to you: (Please do not apply if you are receiving a full scholarship, including books, from another source.)