COMPLETE ALL QUESTIONS CCBC Catonsville Yearly Scholarship Application     First Name: _____________________________ Last Name: _________________________________   SS#: ______________________ Date of Birth: __________________ Gender: _________________   Are you a U.S. citizen? Yes____ No ____ Marital Status: ____________   Permanent Address (where you want mail sent for, at minimum, the next six months): Street_______________________________________________________________ Home Phone______________________ City______________________________ State________ Zip Code_______ Work Phone_____________________   Have you completed a Financial Aid Form (FAFSA)?   Yes __    No  __ (If no, you are not eligible for scholarships requiring demonstration of financial need.) Are you currently receiving: Scholarship(s): (please list which ones) _______________________________ Amount per year:_____ ____________________________________________________________________ Amount per year:_____ ____________________________________________________________________ Amount per year:_____ Employer Tuition/Book Benefit: ______________________________________ Amount per year:_____ Other Financial Aid (please list types) ________________________________ Amount per year: _____ ___________________________________________________________________ Amount per year: _____ ___________________________________________________________________ Amount per year: _____    Are you currently employed? Yes___ No___ On Campus? Yes___ No___ Number of Hours/Week:____ Hourly Wage: $_________ Curriculum/Major:___________________________________________________ Degree ___ Certificate ___ Expected Date of Graduation: ___________________ Are you studying full-time? Yes ___  No ___  Part-time?  Yes ___  No ___ (Full-time is 12 or more billable hours per semester, Part-Time is 9 to 11 billable hours per semester) How many college credits have you earned? __________ as of ____________(please indicate current date) How many credits do you palan to take next year? ___________ (please indicate the total number of credits you plan to take for the next academic year; include all semesters, fall through summer) List any activities, either in school or in the community, which you are currently participating in: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Are you a participant of Project Second Start? _____________ There may be scholarships available that can only be awarded to people with certain disabilities. If you would like to be considered for this type of scholarship, please review the criteria for the scholarship(s) and list any relevant disabilities you may have. Verification of the disability may be required. Please list the scholarship(s) for which you wish to be considered. Please review carefully the criteria sheets for any scholarships for which you wish to be considered. You are responsible for all necessary documents. Incomplete documentation may make you ineligible. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ In what area do you reside?      Catonsville-Arbutus-Halethorpe-Lansdowne-Relay    Hunt Valley-Towson-Timonium-Cockeysville Randallstown-Woodlawn Baltimore City Pikesville-Owings Mills-Reisterstown Other (identify) __________________________________________     What are your educational and career plans? (Type your answer on a separate attached sheet. Be as complete as possible.) The above information is true, current, and complete to the best of my knowledge.     Signature: __________________________________________ Date: ______________       *** Your scholarship application must contain the following: This application completed with your response to question # 11 attached. College transcript(s) (include if you have taken any college courses). High school transcript (include if you have not taken any college courses or if you are a PEP student). Any special documentation required in scholarship criteria (e.g. letter of recommendation, portfolio, or additional essay). Please review carefully the criteria sheets for any scholarships for which you wish to be considered. You are responsible for all necessary documents. Incomplete documentation may make you ineligible. By submitting this application, you are authorizing the Scholarship Selection Committee to review your academic record as well as your financial aid record. Mail to:   CCBC Catonsville Financial Aid Office K Building, Room 204 800 South Rolling Road Baltimore, Maryland  21228
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