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You must have JavaScript enabled to use this form.
Name
- Select -
Mr.
Ms.
Mrs.
First Name
Last Name
Suffix
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Jr.
Sr.
II
III
Mailing Address
Address Line 1
City
State
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AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip Code
Physical Address * If different
Address Line 1
City
State
- None -
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip Code
WCC Student ID#
If you have never attended a Virginia Community College, you may enter seven 0's in this field. If you have ever attended Wytheville Community College or another Virginia Community College, please enter your student ID number in this field.
WCC Student ID# Confirmation
Please enter WCC Student ID# again for verification.
Year of Birth
Preferred Contact Phone #
Alternate Contact Phone #
Email
A request for more information may be sent by email.
Preferred Contact Method
Email
Phone call
Text Message
Text Messages
Yes, I agree to accept text messages from the WCC Foundation Office.
No, please do not contact me by text message.
* I understand that the WCC Educational Foundation may contact me by text message and that standard rates and data fees may apply. Contact your cellular provider regarding fees.
Cell phone number
Cell phone provider
Alltel
Sprint
US Cellular
Verizon
Area of service region in which you reside
- Select -
Bland
Carroll
Galax
Grayson
Smyth
Wythe
Other
High School Attended
- Select -
Bland County HS
Carroll County HS
Fort Chiswell HS
Galax HS
George Wythe HS
Grayson County HS
Marion Senior HS
Mount Rogers HS
Patrick County HS
Rural Retreat HS
Home Schooled
Year of High School Graduation
Later than Spring/Summer 2018 not eligible for a scholarship at this time.
OR Year of GED Received
Did you complete your entire Junior and Senior year in a Wythe or Bland County public, private, or home school?
- Select -
Yes
No
Will this be your first semester in college (not counting dual credit)?
- Select -
Yes, this will be my first semester in college
No, this is not my first semester in college but it will be my first certificate/degree program
No, I have a certificate
No, I have an associate"s degree
No, I have more than one associate"s degree
No, I have a bachelor"s degree
No, I have a post graduate degree
Will you be receiving any other tuition assistance other than WCC Financial Aid?
Yes
No
If "yes," please list the agency name:
In what certification or training program do you plan to enroll?
- Select -
Mechatronics
Nurse-Aid training
Power line Worker training
Truck driver training
Underground Power training
Welding
What is your anticipated WCC graduation date?
State as 'month/year'
Are you an honorably discharged Veteran?
Yes
No
Application Essay
Please type an essay in the space provided above. Please use this section to tell the WCC Scholarship Award Committee about yourself. The application essay should be no longer than one page in length. You may include any of the following in your essay: Educational and Career Objectives: Proposed future occupational or professional field and continuing educational goals (if now known) and how the scholarship will help you achieve your goals. Financial Need: Please explain any unusual circumstances that affect your financial need.
You must complete a FAFSA (Free Application for Federal Student Aid) to be considered for a Foundation scholarship. You do not need to complete a FAFSA to be considered for a Workforce Grant unless you are also applying for the Wythe-Bland scholarship. Please select one of the following:
I have submitted a FAFSA
I will be submitting a FAFSA as soon as possible
I will not be submitting a FAFSA because I am only applying for a workforce grant and not a scholarship.
I authorize Wytheville Community College to release any information requested from my student account including Financial Aid Data to the WCC Educational Foundation Scholarship Award Committee and authorize the WCC Educational Foundation Office to share application and award information with WCC including the Financial Aid Office and the Workforce Development Office.
Yes
I authorize the WCC Foundation Office to verify information contained in this application.
Yes
I hereby certify that, to the best of my knowledge, the information submitted in this application is complete and correct.
Yes
Student Name
Parent or Guardian Name
If student is under the age of 18
Leave this field blank
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