SPOON RIVER COLLEGE/SRC FOUNDATION
SPRING 2018 FELLHEIMER Scholarship Application
MACOMB CAMPUS STUDENTS ONLY
Deadline February 28, 2018

Please neatly complete all information below. You must also complete or have completed a FAFSA for the 2017-18 academic year. Failure to complete the FAFSA or to fully complete this application will make the applicant ineligible for award.

PERSONAL DATA
Legal Name: (Last First Middle)
SRC Student ID #
Date of Birth (MM-DD-YYYY)
Street Address
Email Address
City / State / Zip Code
Home Telephone # / -- / Cell Phone # / --
APPLICATION STATUS
Applying for the following term (check one) / Fall / Spring / Summer
I am a (check one) / new SRC student / returning SRC student
I will be attending (check one) / full time (12+ hours) / part-time (under 12 hours)
I am classified as a (check one) / freshman (0-29 hours) / sophomore (30+ hours)
I received an SRC scholarship in the previous year (check one) / yes / no
I have submitted the FAFSA (check one) / yes / no / If yes, list date submitted
I have requested all transcripts be sent to
SRC Financial Aid Office or have transcripts on file at SRC (check one) / yes / no / If yes, date requested
EDUCATIONAL BACKGROUND
Name of High School / City, State / ,
Date of Graduation / Cumulative GPA / on a scale of
Name of College / City, State / .
Dates Attended / From to / Cumulative GPA
# of Credit Hours Earned / Program of Study
I am interested in the following program(s) of study at SRC (i.e. Ag, General Studies, English)
Please list areas of interest for SRC College Life (e.g. Student Government, Athletics (baseball, softball, golf, cross country), Ag/Livestock Judging, Nursing, Writing/Journalism, Art, Drama, Chorus, Habitat for Humanity, Honors, TRIO, etc.)
Please comment on any school or community activities you have participated in or any other information you wish for the scholarship committee to consider.

AFFIRMATION

I have read and understand all criteria and requirements regarding Spoon River College Scholarships

and SRC Foundation Scholarships and understand that, if I have left any field on this form blank, it can be grounds for immediate and automatic denial of my application.

The preceding information I have supplied on this application form is correct. If I receive a scholarship, I understand I must adhere to all requirements for that scholarship. I am not in default on any student loan(s). I also give my permission to Spoon River College to request and obtain any related information that would be pertinent to my application and share my information with committees reviewing applications for scholarships. I allow SRC to publish my name as a scholarship recipient but understand no other personal information will be published. I understand that scholarship awards will first be applied to my SRC account to cover any balance due. I also understand that some awards may be made AFTER a semester begins.

Student Signature ______Date ______

Parent Signature for Minor ______Date ______

Please print and mail/deliver this form to:
Spoon River College

Student Services Office

208 South Johnson

Macomb, IL 61455-2137

Deadline February 28, 2018

SRC is an Affirmative Action/Equal Opportunity Employer. It is the policy of Spoon River College to be in full compliance with all federal and state nondiscrimination and equal opportunity laws, orders, and regulations. They will not discriminate against any person because of race, color, religion, national origin, sexual orientation, age, handicap, marital status, or status as a disabled veteran or veteran of Vietnam era in any educational program and activities.

updated 2/2018

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