Online Application Form — Central Piedmont Community College

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Scholarship Application

Instructions

To be considered, turn in a completed application with all applicable signatures to the Financial Aid Office.
Submit a new application each academic year or as required by scholarship criteria.
Check for specific scholorship criteria and other relevent information at: http://www.cpcc.edu/finanical_aid/scholarships .
College/Foundation may require an attached written statement describing educational goals and other relevant information (see specific scholarship criteria).
Please initial all items under the Authorization Information section

Personal Information

Name:

CPCC Student ID #:

You need a CPCC Student ID# in order to apply for a scholarship. If you do not have one, you must apply for admission.

Address: Apt #:

City: State: Zip:

Home Phone: Alt Phone:

Email Address:

Current CPCC Students

Have you completed the free application for student aid (FASFA)?
Yes
No

Are you presently receiving a CPCC scholarship(s)?
Yes
No

If so, please name:

Do you have other sponsors paying tuition and book(s)?
Yes
No

If so, please name:

What is your program of study/major?

What is your GPA?

How many credits have you completed?

Are you enrolled:
Full Time
Part Time

What are your career goals?

High School / Adult High School / GED Students

What is the name of your school?

City and state of your school:

What is your graduation date? (MM/YYYY)

What is your cumlative GPA?

Indicate your course of study:

Have your offical transcripts been sent to CPCC?
Yes
No

What is your planned program of study at CPCC?

If you graduated or will graduate this year, have your Guidance Counelor or Registrar sign here:

Authorization Information

I release to Central Piedmont Community College (CPCC) and the CPCC Foundation the right to access all my current and ongoing personal and education records at CPCC. If awarded a scholarship, I understand that I must meet the scholarship criteria and Standards of Academic Progress for CPCC and the CPCC Foundation.
I understand my name and information from my academic history may be released to the scholarship selection committee and the scholarship donor(s). If awarded a scholarship, I release to CPCC and the CPCC Foundation, the right to arrange a meeting with the donor(s) and use my name, story, and picture for printed and video materials, reports, and press releases, without compensation, as well as I will attend ceremonies and receptions. I also recognize the advisability of communicating a letter of thanks to the donor of the scholarship.

I certify that the statements contained herein are true to the best of my knowledge and grant my permission for the information contained herein to be shared with the scholarship selection committee and scholarship donor(s).
Your Initals Date

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