Forsyth Tech Application for Scholarship Consideration 2009-2010

Application Information & Instructions

Please print or type clearly.

1. Complete all questions on the Scholarship Application. If a question does not pertain to you, please
write in "Not Applicable" or "NA." Be sure to complete and submit all sections of the Scholarship
Application. Your application will not be considered if any of it is incomplete.
2. Use your school ID, not your social security number on your application. If you will be new to
Forsyth Tech for Fall 2009, contact the Admissions Office to receive your Forsyth Tech ID.
3. Attached to this application are two reference forms. You must submit a reference from one of your
full-time faculty. The other reference must be from your current or most recent employer. If you
have not been employed for several years, you may request a second faculty reference. If you have
not been in school in the past four years, you may use two employment references. Attach required
references to the back of your application before submission to the Office of Student Financial
Services.
4. You must have applied for admission or readmission or be currently enrolled by April 15, 2009.
Students who have not applied for admission by then will not be considered for this scholarship
competition.
5. Required transcripts must be received by April 15, 2009.
6. You are not required to submit the Free Application for Federal Student Aid (FAFSA) but financial
need is a requirement or a priority for all of the scholarships under consideration. It is very difficult
to receive a scholarship without having the FAFSA information on file with our office. Your results
should be here by May 1, 2009 to be considered.
7. By signing and submitting this application you are giving the scholarship committee the
authority to review your academic transcript(s) and your financial need.

The completed scholarship application is due by Wednesday, April 15, 2009 at 7 pm. Return it to the
Office of Student Financial Services, Allman Center, Room 261.

Incomplete and/or late applications will not be considered. All parts of the Scholarship
Application must be submitted directly to the Office of Student Financial Services by the
deadline date.

Scholarship Notifications
The Scholarship Committee will review Scholarship Applications after spring grades become available. All
applicants will be notified of scholarship decisions by mail no later than July 31, 2009.
Your application will be reviewed by the Forsyth Tech Scholarship Committee after Forsyth Tech Spring
2009 grades are available. You will be considered for all scholarships for which you meet the minimum
requirements. Some scholarships require an essay in addition to the application. If you are interested in
being considered for any of the following scholarships you must attach your essay to your application
before submitting it to the Office of Student Financial Services.

As you write the required essay, include answers to the short-answer questions (Section 5). By including
that information in your essay, you do not have to rewrite the answers to Section 5.

Associate Degree Nursing and Licensed Practical Nursing Scholarships – All Forsyth Tech Nursing
scholarships require you to write a 250 – 500 word essay. The topics to be included are:
• Why have you have chosen to become a nurse?
• Is there a particular branch of nursing that interests you more than others?

Charlie King, Student Development Memorial Scholarship – Requires you to write a

250 – 500 word essay. The topic is:
• Why have you chosen to apply for this scholarship?

Ivy Lamb Scholarship - Requires you to write a 500 word essay. The topic is:
• International Business

Society for Manufacturing Engineers Scholarship - Requires you to write a 250 - 500 word essay. The
topic is:
• Why have you chosen to apply for this scholarship?
 Forsyth Tech Scholarship Application
All parts of the Scholarship Application should be completed, attached, and turned in to the Office of
Student Financial Services no later than Wednesday, April 15, 2009 at 7 pm.

Section 1 General Information

____________________________________________________ __________________
Last Name First Name MI College ID

Mailing Address City State Zip

____________________________________________________ ___________________
E-Mail Address Date of Birth

___________________________ ______________________ ___________________

Home Telephone # Cell Phone # Work Phone #

_____________________________ ____________________________
State of Legal Residence County of Legal Residence

Have you completed and submitted the 2009-2010 FAFSA? Yes [ ] No [ ]

List other types of assistance (i.e. Voc Rehab, Veteran’s Benefits, WIA, W-S Foundation, Tuition
Reimbursement, Outside Scholarships and Loans, etc.) you have either applied for and/or been awarded for
the 2009-2010 academic school year.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Race:
African-American [ ] American Indian/ Native Alaskan [ ]
Asian/ Pacific Islander [ ] Caucasian/Non-Hispanic [ ]
Hispanic [ ] Other [ ] ________________________________

Male [ ] Female [ ]

Are you married [ ] separated, divorced, or single [ ] ?

If you have children or other dependents, list their ages.
__________________________________________________

Do you pay for child care services for any of the above? Yes [ ] No [ ] If so, where?

__________________________________________________
____________________________________________________ __________________
Last Name First Name MI College ID

Are you currently employed? Yes [ ] No [ ]

If yes, where?_________________________ How many hours a week? _______Did you cut back on your
hours in order to attend school? Yes [ ] If so, how many? ___________ No [ ]

If not employed, where were you last employed? _____________________ How many hours a week? ____
When did you leave?___________ Did you leave your position in order to attend school? Yes [ ] No [ ]

Section 2 College Plans

Your 2009-2010 curriculum at Forsyth Technical Community College is ___________________________

Your expected graduation date from Forsyth Technical Community College is _________

What level of education are you pursuing? (Check only one)

Associate Degree [ ] Diploma [ ] Certificate [ ]

What are your enrollment plans for 2009-2010?

I intend to enroll in Forsyth Tech. Yes_____ No_____ If returning, check one for each term.
Fall 2009 12 or more credits [ ] 9 – 11 credits [ ] 6 – 8 credits [ ] Less than 6 credits [ ]
Spring 2010 12 or more credits [ ] 9 – 11 credits [ ] 6 – 8 credits [ ] Less than 6 credits [ ]
Summer 2010 12 or more credits [ ] 9 – 11 credits [ ] 6 – 8 credits [ ] Less than 6 credits [ ]

I intend to transfer to another college Yes____ No____Which college?_______________________

Full-time______ Part-time________

Section 3 Transcripts
Have you been enrolled at Forsyth Tech prior to Fall, 2009?
Yes [ ] Your Forsyth Tech transcript will be pulled for you.
No [ ]

Have you been enrolled in any other college?

*Yes [ ] We will need an official college transcript from all other college’s previously attended.
*No [ ]

We will need an official high school transcript if you have never been enrolled in college.
Current high school students should submit a current transcript. A final transcript must be
received by August 15, 2009.
*If you have had your transcripts from other colleges and/or high school sent to Forsyth Tech
previously, we will pull them for you. If not, please request they be sent to you to submit to the
Scholarship Committee.
Section 4 References
Attached to this application are two reference forms. You must submit a reference from one of your
curriculum instructors if you have been enrolled in school within the last four years. The other reference
must be from your current or most recent employer unless you have been out of work for two or more
years; if so, you may substitute a second faculty reference. Attach required references to the back of your
application before submission to the Office of Student Financial Services. Request your references in time
to attach them to your application.

Section 5 Short Answer Questions

On a separate sheet type or handwrite answers to the following questions and attach the sheet to your
application. Answers to these questions are required of all scholarship applicants. If you are attaching an
essay, include the answers to these questions as part of your essay.

1. Why have you chosen to enroll in your curriculum?

2. How does your education commitment impact your job and family?
3. What barriers (child care, transportation, work hours, etc.) impact your ability to complete your
educational requirements?
4. What are your career and future education expectations?
5. What else should the scholarship committee know about you? (special circumstances or challenges,
awards or achievements, community service &/or volunteer activities)

Section 6 Student Signature (Required)

I certify that the information given on this application is complete, accurate, and true. I
understand my signature grants the Office of Student Financial Services permission to
release any information deemed appropriate in corresponding with donors and the
scholarship committee.

Signature Date
 Office of Student Financial Services
261 Allman Center

Faculty Reference Form

2009-2010 Award Year

I am applying for a scholarship through Forsyth Technical Community College. As a reference, you have my
authorization to give the information requested below.

_________________________________________ ______________________________________________
Student’s Name (Please print.) Curriculum

_________________________________________ ______________________________________________
Student’s Signature Date

______________________________________________________ _________________________________
Address City State Zip Daytime Contact Telephone #

How long have you known the applicant? _________________________________________________________

In what capacity? ______________________________________________________________________________

Please check the phrase which best fits the person in each trait listed below:
TRAIT NOT OBSERVED OUTSTANDING ABOVE AVERAGE AVERAGE POOR

School Performance

Initiative

Maturity of Judgment

Interaction with Others

Seriousness of Purpose

Further Comments including barriers to the student’s success:

___________________________________________________________________________________________

___________________________________________________________________________________________

Reference Signature: _______________________________________ Date: ____________________________

Print Name: __________________________________________________________________________________

Address: _____________________________________________________________________________________

Return to the student to be attached to the student’s application.

An Equal Opportunity Educational Institution
2100 Silas Creek Parkway Winston-Salem, NC 27103-5197 (336) 734-7235 Fax (336) 761-2454
 Office of Student Financial Services
261 Allman Center

Employment or Faculty Reference Form

2009-2010 Award Year

I am applying for a scholarship through Forsyth Technical Community College. As a reference, you have my
authorization to give the information requested below.

_________________________________________ ______________________________________________
Student’s Name (Please print.) Curriculum

_________________________________________ ______________________________________________
Student’s Signature Date

______________________________________________________ _________________________________
Address City State Zip Daytime Contact Telephone #

How long have you known the applicant? _________________________________________________________

In what capacity? ______________________________________________________________________________

Please check the phrase which best fits the person in each trait listed below:
TRAIT NOT OBSERVED OUTSTANDING ABOVE AVERAGE AVERAGE POOR

Work or School
Performance

Initiative

Maturity of Judgment

Interaction with Others

Seriousness of Purpose

Further Comments:
___________________________________________________________________________________________

___________________________________________________________________________________________

Reference Signature: _____________________________________ Date: ____________________________

Print Name: __________________________________________________________________________________

Address: _____________________________________________________________________________________

Return to the student to be attached to the student’s application.

An Equal Opportunity Educational Institution
2100 Silas Creek Parkway Winston-Salem, NC 27103-5197 (336) 734-7235 Fax (336) 761-2454