Daytona State College
AFC Chapter
Book/Materials Scholarship Application
A MEMBER OF THE FLORIDA COLLEGE SYSTEM
Name:
Click here to enter text.
Department: Click here to enter text.
CARS ID: Click here to enter text. Campus: Click here to enter text.
Extension: Click here to
enter text.
AFC membership date must be at least 12 months prior to application deadline.
Membership Date: Click here to enter text.
Purpose:
Prof. Skills Dev. ☐
Graduate ☐
Undergraduate ☐
Academic Studies ☐
Job Related Skills ☐
Technical Updating ☐
Credential Renewal ☐
Other ☐
Institution providing course: Click here to enter text.
Semester/Year:Click here to enter text. Number of Credit Hours: Click here to enter text.
Choose one:
Semester Hours ☐
Quarter Hours ☐
Other ☐
Cost of Required Course Materials: $ Click here to enter text.
SIGNATURE/DATE
/
I certify to the best of my ability that all the above information is true.
Proof of passing grade must be provided by including transcript or grade report. (Required grade of:
C or better for undergraduate; B or better for graduate; or, evidence of satisfactory completion for a
non-graded course.) Award based on the funds available and the number of applications submitted.
Courses completed 09/16 thru 01/15:
Courses completed 01/16 thru 05/15:
Courses completed 05/16 thru 09/15:
Application due: 3rd Tuesday of January
Application due: 3rd Tuesday of June
Application due: 3rd Tuesday of September
Email application and evidence of grade/materials costs to latimec@daytonastate.edu and then send the
original documents to Charlene Latimer/Daytona Campus 100/224.
Revised 02/24/2014