QCC Foundation Scholarship Application
Spring 2016 Semester
Due: Tuesday, November 24, 2015
TO:
Quinsigamond Community College Student Applicant
FROM:
Dale Allen, Ph.D. Vice President for Community Engagement
Lillian Ortiz, Ph.D. Vice President of Strategic Enrollment Management and Student
Engagement
RE:
QCC Foundation Scholarship Application Packet
Quinsigamond Community College Foundation Scholarship awards are being administered through the
Community Engagement Office for the Spring 2016 Semester. Attached is the complete packet of
information you will need to be considered for any awards.
The REQUIREMENTS for consideration are:
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Academic Achievement
Full -time or part-time student
GPA 3.0 or higher
Completed at least one full semester at
QCC
Extracurricular or volunteer activities
Recommendation
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Financial Need
Full-time, part-time, new student
GPA 2.5 or higher
Evidence of significant financial need that
presents a barrier to completing your
education. (FAFSA or other
documentation required)
Extracurricular or volunteer activities
Recommendation
Full-time and part-time students are encouraged to apply and past scholarship recipients are welcome to
re-apply. If your GPA is not a minimum of 2.5, please tell us why on a separate sheet of paper.
The best assurance of attaining a scholarship is to turn in a complete application including a wellwritten essay that addresses the questions asked in the checklist. The Academic Advising Center,
located in Room 61A of the Administration Building, and the Financial Aid Office, located in Room
165A of the Administration Building, can provide information and assistance in completing parts of the
application.
The deadline for the Spring 2016 semester scholarship applications is:
Tuesday, November 24, 2015 at 4pm
Incomplete applications will be disqualified.
Drop off your completed application package to
QCC Foundation Scholarships
Room 133A-Administration Building
670 West Boylston Street
Worcester, MA 01606
Or mail your completed application to
QCC Foundation Scholarships
670 West Boylston Street, Mailbox 19
Worcester, MA 01606
Questions regarding technical assistance should be directed to Shirley Dempsey at 508.854.4520 or
sdempsey@qcc.mass.edu
QCC Foundation Scholarship Application
Spring 2016 Semester
Only completed applications will be accepted – PLEASE TYPE OR PRINT LEGIBLY
Name of Applicant:
QCC ID Number:
Last
First
M. I.
Address:
Street
City/Town
Email Address:
Zip Code
Phone:
Ethnicity (optional): American Indian/Alaskan Native ☐
Asian ☐
Native Hawaiian or Other Pacific Islander ☐
Work Status:
State
Full Time ☐
Part Time ☐
Black or African American ☐
White ☐
Unemployed ☐
What is the highest level of education your parents achieved?
Hispanic/Latino ☐
Other ☐
# of Family Members in College:
Mother:
Father:
Date enrolled at QCC:
Anticipated Graduation Date:
Grade Point Average to date (if applicable):
Credits Earned to date (if applicable):
Degree Program
Certificate Program ☐
Major currently enrolled in:
Full Time ☐ or
I am registering for
credits during next semester, as a
Are you an international student? Yes
☐
Yes ☐
If yes, explain:
Are you on Academic Probation?
Yes ☐
Part Time ☐
No ☐
Have you ever violated the QCC Code of Conduct?
If yes, explain:
☐ or
No ☐
No ☐
student.
Extracurricular activities and volunteer work–Please list any extracurricular activities and volunteer work you
participate in, both in your community and at QCC (faith-based, PTA, school clubs, etc.). You may include
past activities as well.
If your GPA has fallen below 2.5, please explain why here:
I have carefully read and completed this application and, to the best of my knowledge, the above information is
true. I understand that this application material will be kept confidential.
__________________________________________________
___________________
Signature
Drop off your completed application package to
QCC Foundation Scholarships
Room 133A-Administration Building
670 West Boylston Street
Worcester, MA 01606
Or mail your completed application to
QCC Foundation Scholarships
670 West Boylston Street, Mailbox 19
Worcester, MA 01606
Date
Recommendation Form for Scholarship
PLEASE TYPE OR PRINT LEGIBLY
Name of Applicant:
QCC ID Number:
Last
First
M. I.
I have known the applicant for (period of time):
I know this applicant as (i.e.; student, employee, work-study student, volunteer):
Please rate the following characteristics of this applicant (select one rating per line).
Academic Performance
Outstanding ☐
More than satisfactory ☐
Average ☐
Below Average ☐
Not Applicable ☐
Character/Performance
Outstanding ☐
More than satisfactory ☐
Average ☐
Below Average ☐
Not Applicable ☐
Motivation
Outstanding ☐
More than satisfactory ☐
Average ☐
Below Average ☐
Not Applicable ☐
Leadership Qualities
Outstanding ☐
More than satisfactory ☐
Average ☐
Below Average ☐
Not Applicable ☐
Community Service
Outstanding ☐
More than satisfactory ☐
Average ☐
Below Average ☐
Not Applicable ☐
Please provide any information or support that you feel would assist the applicant in being selected as a recipient of a Quinsigamond
Community College Foundation Scholarship Award.
Signature
Date
Printed Name
Title
Please return by Tuesday, November 24 to:
Quinsigamond Community College Foundation Scholarships
670 West Boylston Street, Mailbox 19
Worcester, MA 01606
Scholarship Information Release Form
Quinsigamond Community College (QCC) Foundation scholarships are made possible through the contributions
of various individuals and organizations. These donors appreciate learning more about the students who directly
benefits from their scholarship funds. By allowing the college to provide recipient information to our donors, you
are helping to strengthen their connection to QCC.
We also like to share scholarship recipient information with the offices and organizations that work so very hard
to raise scholarship funds for QCC students and for publicity releases. Your cooperation with the efforts of
QCC’s Marketing and Public Relations Department, Alumni Association, Community Engagement Office, and
QCC Foundation will help to increase the funds available to assist current and future QCC students with their
education.
The Family Education Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law
that protects the privacy and confidentiality of student education records. In order for the college to release your
information, we must have written permission from you.
I authorize QCC to release my information and photo to donors and other individuals responsible for funding my
scholarship(s). I also authorize QCC to release my information and photo for publicity releases and other
promotional and/or marketing material related to QCC.
Signature
Date
Printed Name
QCC ID
QCC Foundation Scholarship Checklist
Please submit your application documents in this order.
o Scholarship Application: Applicants must be a full time or part time student, enrolled in a
degree or certificate program, in good academic standing with a GPA of 2.5 or better.
o Essay: One- to two-page typed essay addressing all of the following questions:
1. Imagine yourself 10 years from today. What goals and ambitions do you have for yourself,
personally and professionally?
2. Pick an experience from your own life and explain how it has influenced you.
3. Describe your family background. How has your family background affected the way you
see the world?
4. Acquiring new knowledge and skills is an integral part of your QCC educational experience.
Please describe some knowledge or skill at QCC that you find most exciting or rewarding,
and explain why.
o Recommendation: From a faculty/professional staff, employer or member of the community.
Applicants must ensure that recommendation forms are submitted by the deadline.
o Resume: List any extracurricular activities and volunteer work (especially activities at QCC)
o Release Form
o Transcript: Please provide an unofficial copy of your current QCC transcript.
o Financial Statement: Financial statement must only be completed for financial assistance
applicants.
o Applicants must complete the Free Application for Federal Student Financial Aid
(FAFSA) and provide a copy of your SAR (student aid report).
o International students or students who cannot receive financial aid should submit a
statement regarding their financial situations.