SCHOLARSHIP APPLICATION Asnuntuck Community College Foundation, Inc. 170 Elm Street, Enfield, CT 06082 860-253-3041 860-253-3007 (fax)
Please see attached for scholarship requirements and overview. You may submit for more than one scholarship on this application; please check all that apply: DEADLINE: All materials must be received by Friday, March 31, 2016, 4:00 p.m. STUDENTS: Please complete this application to apply for the listed scholarships. Be sure to sign and date
it, enclose all required materials (see requirements page), and return everything to: Financial Aid Office at 170 Elm Street, Enfield, CT 06082 (fax 860-253-3007), by Thursday, 03/31/16, 4:00 p.m. Please print and attach any additional information you would like to share with the Scholarship Committee. All applications must be complete and meet the requirements of each scholarship. Name
Asnuntuck ID # @ Last
First
Middle
( if applicable)
Email Address Street Address City
State
Date of Birth
Daytime Phone
High School
Zip
High School Graduation Date
When will you enter Asnuntuck Community College? (Month/Year)
Asnuntuck Program of Study Please list your school and community activities, including dates. (Examples: “Extracurricular: Patient Services Volunteer, Hartford Hospital.” “ Senior Class Officer.”)
What do you plan to do after graduating from Asnuntuck?
Expected graduation date? (Month/Year)
BE SURE TO COMPLETE THE APPLICATION IN FULL AND ATTACH MATERIALS REQUIRED FOR SCHOLARSHIP(S) YOU SEEK, INCLUDING TRANSCRIPT(S), RECOMMENDATION LETTER(S), AND YOUR ESSAY(S)
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STUDENT CERTIFICATION I declare that the information reported on this application is true and accurate. I authorize Asnuntuck Community College to release information regarding my scholarship application, which may include financial aid information if applying for a scholarship that must demonstrate financial need. I have attached all of the materials for this application as outlined on the requirements sheet.
SIGNATURE
DATE
Please place a check next to the scholarship(s) in the category you are applying for. CURRENT ACC SCHOLARSHIPS ACC Foundation Scholarship (5 scholarships available)
Edward & Catherine Juozokas Scholarship
Andrew Associates Scholarship
Joyce Keating “Woman In Business” Scholarship
Birken Mfg. Scholarship
Nadia Kober Writing Scholarship
Dardanelli Criminal Justice Scholarship
Anne Mazza Alumni Scholarship
Early Childhood Education Scholarship
William J. McGurk Scholarship
Gasparino Scholarship
Dr. Martha McLeod Scholarship
Human Services Scholarship
Micro Science Scholarship
Jarmoc Scholarship
Judith K. Shaffer Memorial Scholarship (2 scholarships available)
ACC CONTINUING EDUCATION SCHOLARSHIPS Melody Parlos Memorial Continuing Education Scholarships (4 scholarships available)
HIGH SCHOOL SCHOLARSHIPS Robert McDonald Scholarship Fund (1 scholarship available)
Simanski Family Scholarship Fund (1 scholarships available)
Dr. Martha McLeod Scholarship (1 scholarship available)
William J. McGurk Scholarship (1 scholarship available)
All applications must be complete and meet the requirements of each scholarship. Be sure to sign and date your application, enclose all required materials (see requirements page). Please be sure everything arrives at the Financial Aid Office by Thursday, 03/31/16, 4:00 p.m. 170 Elm Street, Enfield, CT 06082 (fax 860-253-3007) For questions regarding the application process, please contact: Keith Madore
[email protected] 860-253-3041
BE SURE TO COMPLETE THE APPLICATION IN FULL AND ATTACH MATERIALS REQUIRED FOR SCHOLARSHIP(S) YOU SEEK, INCLUDING TRANSCRIPT(S), RECOMMENDATION LETTER(S), AND YOUR ESSAY(S)
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