MCC
Student ID #
OFFICE
USE ONLY
Date
PERFORMANCE-BASED SCHOLARSHIP
APPLIED TECHNOLOGY DEPARTMENT
APPLICATION FORM – Part 1
ELIGIBILITY:
These scholarship awards are based on the student’s aptitude or an interest as indicated by grades and
recommendations. The applicant must have at least a 2.0 overall high-school average. Student must enroll in
coursework in the area of study for which they are applying. Additional requirements specific to the area of
study are listed in PART 2.
TO APPLY:
PART 1 of this application is demographic information and must be filled out completely. PART 2 contains the
requirements specific for the discipline or department to which you are applying. Completed recommendation
forms, filled in by your high school teacher(s) and/or your counselor, must be attached. Please have your
counselor mail the recommendation forms and HIGH SCHOOL TRANSCRIPT addressed to the relevant
department at:
Applied Technology Department
MUSKEGON COMMUNITY COLLEGE
221 S. QUARTERLINE ROAD
MUSKEGON, MI 49442
(You must provide your teacher/counselor with a stamped envelope for this purpose)
DEADLINE:
st
This application with all relevant information must be post-marked/received by April 1
Applications received after this date will not be considered.
PART 1
Name:
Last
Middle
Address:
Street
First
City
Contact
Information:
Home:
State
(
Zip
)
Cell:
Email:
Social Security Number:
XXX – XX -
(last four digits only)
High School
Name & City
Graduation Date:
High School GPA
Official High School Transcript should be sent with this application.
Are you eligible for other scholarship(s) or aid?
(If yes, please list)
Have you applied for a Performance-Based Scholarship
from any other department at Muskegon Community
College? (If yes, please name the department)
Yes
Yes
No
No
If successful, when would you like the award to begin:
PART 2 –on next page must be completed
Fall
Winter
PERFORMANCE-BASED SCHOLARSHIP
APPLIED TECHNOLOGY DEPARTMENT
APPLICATION FORM – Part 2
PART 2
PREVIOUS COURSE WORK:
List related technical courses of study and final grades.
_
_
_
MCC APPLIED TECHNOLOGY PROGRAMS:
Of the following technical programs offered at Muskegon Community College, which o ne(s) are you seeking
a performance based scholarship for?
Automotive Technology
Industrial Technology
Computer-Aided Design
Electronics Technology
Graphic Design
Machining Technology
Materials Technology
Welding Technology
WRITTEN COMPONENT:
Please respond to the following questions below on a separate sheet of paper. Attach your answers with the
questions to this application (they must be typed):
1.Describe any past accomplishments, employment, experiences, special skills, project or activities which
will support your desire for additional training within a technical program at Muskegon Community College.
2.Provide a brief statement answering the following question: "Why did you choose Muskegon
Community College to further your knowledge of a specific technical field."
Please indicate the name(s) of those you have requested recommendations from.
Name
Title
Name
Title