EmailMe Form - GCC Member Spouse Continuing Ed. Scholarship 2024

PRIVACY ACT STATEMENT
Under authority of U.S. Title 10, Section 3012, the enclosed personal information will be maintained by the Scholarship Committee for administrative use and released only to the individuals needed to evaluate the application. The disclosure of the information is voluntary; however, failure to disclose all or part of the requested information may hinder evaluation of the application. The application will remain in the possession of the Scholarship Committee Chairperson for one year and will then be destroyed.

Statement of Understanding
I certify that the information in this application is true and correct to the best of my knowledge. I understand that I will be disqualified if I include false information in this application. I agree to abide by the conditions of the Scholarship Committee and in no way shall question their selection of the winners. I understand that the GCC Scholarship Committee reserves the right to contact individuals listed on this application.

I certify that the essay is my original work and I have signed and completed the acknowledgement statement listing any advice or assistance I have received. *

e-Signature of Applicant and Date

• Selection process is anonymous and packet identification will be by applicant’s Identification Code
• The selection panel will judge applications with all other identifying information removed.
• Make certain each separate document submitted has the applicant’s Identification Code in the upper right hand corner.
• Make a copy of this application for your records

Your Identification Code is the first letter of your first name, the first letter of your last name and the first 3 numbers of your social security number. *

Applicant's Identification Code

Name *

First MI Last

Email *

Phone *

APO Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Sponsor's Name *

First MI Last

Sponsor's Organization *

Sponsor's Email *

Sponsor's Duty Phone *

Your highest education level: *

College/Institution of current enrollment *

What is your current course of study? What degree program do you plan to complete? What are your career plans? *

List all high schools, colleges and institutions you have attended. Include dates attended, G.P.A., and degree attained, if any. *

Activites

Are you currently employed? *

Yes

No

If yes, list your empolyer

Employment *

List all paid employment and internships beginning with the most recent going back five years. Include position held, hours per week, length of employment, and supervisor’s name and email (or specify self-employment). Employment pursued while a student in high school is not relevant to this application.

Community and Volunteer Service - Please include dates, location, organization, position, and hours. If none specify N/A. *

List all volunteer activities beginning with the most recent going back five years. Activities pursued while a student in high school are not relevant to this application.

Community Activities - Please include location, organization, position, dates, and hours. If none specify N/A. *

List all community activities beginning with the most recent going back five years. Activities pursued while a student in high school are not relevant to this application.

Leadership, Awards, Achievements, and Honors - Please include date, activity, award/achievement/honor, and location. If none specify N/A. *

Please list all Awards, recognition, certificates, etc. that you have received for work performance, volunteer services or community-related services. Include any academic honors or awards in this section.

List any hobbies or interests not listed above.

Are there any extraordinary circumstances you would like the committee to know about that have affected your transcripts and/or application? (Academic or extracurricular)

ACKNOWLEDGEMENT STATEMENT
In order to evaluate applications fairly and to preserve the integrity of the preparation process, the scholarship committee requests that every applicant complete an acknowledgement statement. Each applicant is expected to complete the packet and write and proofread the essay themselves and the result should be the applicant’s own work. However, the committee understands that an applicant might ask a family member or colleague to provide a second proofing of the essay or review the packet to be sure that it is complete. Respectfully, the committee requires that each applicant acknowledge and provide details of any assistance he or she might have received by completing the acknowledgement statement below.

I pledge that I have prepared the scholarship application packet myself and that the essay and the forms are my own work. *

e-Signature of Applicant and Date

In completing my work, I have used the following resources or accepted the following types of assistance (for example, essay proofed by a colleague): *

Please complete the following items offline:

One (1) recommendation letter completed by someone other than a family member or another student – pdf or .doc file sent directly from recommender to GCCScholashipChair@gmail.com.

Name and email address for recommender *

Essay - Actress Lily Tomlin said, “I always wanted to be somebody, but now I realize I should have been more specific.” What are your goals, academic and beyond, and how did they become known to you? Why is now the right time for you to pursue them? *

Keep in mind the following:

1. The essay should be:
• a .pdf file
• 12 point, double-spaced, with one inch margins
• 300-500 words
• include a word count at the end

2. Please include your Identification Code, not your name, in the upper right hand corner of each page.

3. The essay will be evaluated on style and content, and must be grammatically correct.

4. Points will be deducted from essays that exceed the word limits.

5. Include any assistance you receive on your Acknowledgement Statement.