NCCC SCHOLARSHIP APPLICATION FORM
PLEASE SUBMIT TWO (2) COPIES OF ENTIRE PACKET; APPLICATION, TRANSCRIPTS, ESSAY, ETC. AND
RETURN IT TO THE SCHOLARSHIP OFFICE LOCATED WITHIN THE FINANCIAL AID COMPLEX (A-114)
(Use for General Scholarship Opportunities Only)
List all scholarship(s) you are applying for below.
___________________________________________
__________________________________________
___________________________________________
__________________________________________
___________________________________________
__________________________________________
Check 
First time student to NCCC
 Transfer student to NCCC
 Continuing student at NCCC
What Other Sources of Funding Have You Received And/or Are Currently Receiving?
 Tap
 Pell
 Loans
 Other Scholarships (Please List) ______________________________________
Are You Currently Employed?
 No  Yes (List place of employment and # of hours you work per week) __________________________________
Major ______________________________ Accepted into Program Yes
No
Transcript - PLEASE ATTACH 2 COPIES OF YOUR TRANSCRIPT
(EITHER OFFICIAL HIGH SCHOOL OR UNOFFICIAL COLLEGE) FROM YOUR MOST RECENT SEMESTER.
Essay - This essay is mandatory for all scholarships.
Many scholarships require additional information other than the
topics listed below. Please incorporate all information for all scholarships into one (1) essay. Essays must
be typewritten and submitted with the application. Within your essay, please address the following topics:
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How you will use your education at NCCC to reach your goals.
Include a goal statement, including a course of study at NCCC.
Indicate how the College and/or community will benefit from your particular endeavors.
Explain specifically why you need financial assistance and how you will use the award.
Include any additional information you think the scholarship review committee may find helpful in the
evaluation of your application.
Name
____Email Address________________________________________
Address_________________________________________________________________________________________________
City, State, Zip
____NCCC @ #____________________________________________
Telephone No.____________________________________Year of High School Graduation________________________
* Ethnicity: Caucasian/Non-Hispanic
African American /Non-Hispanic
Hispanic
Asian/Pacific Islander
Native American/Alaskan
I do not wish to give this information
I permit authorized NCCC personnel and the Scholarship Committee to access my academic and financial aid records by
signing this document. All Committee discussions are confidential. Decisions are based on the information you include in
your essay and your academic achievements including GPA. All decisions are final.
______________________________________________________
______________________________________
Applicant’s Signature
Date
IT IS THE APPLICANT’S RESPONSIBILITY TO REQUEST AND SUBMIT ALL SUPPORT MATERIALS. INCOMPLETE
APPLICATIONS AND/OR THOSE LACKING ANY SUPPORT MATERIALS WILL NOT BE CONSIDERED. IT IS THE
APPLICANT’S RESPONSIBILITY TO INFORM THE SCHOLARSHIP OFFICE OF ANY CHANGES OF ADDRESS,
EMAIL AND PHONE NUMBERS.
Return scholarship packet to: the NCCC Scholarship Office located in the Financial Aid Complex A-114, 3111
Saunders Settlement Road, Sanborn, NY 14132 by Friday, October 1, 2010 either hand delivered or postmarked
by due date. If you have any questions, please contact the NCCC Scholarship Office at 716-614-6205.
NCCC will not discriminate against any employee or applicant because of race, creed, color, sex, national origin, age,
disability, sexual orientation, Vietnam veteran status or marital status. NCCC is an Affirmative Action/Equal Opportunity
SUNY institution.
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