Personal Information

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Last Name:

First Name:

Middle Name:

Last 4 digits Social Security Number:

Birthdate:

Email Address:

Home Phone:

Cell Phone:

Street Address:

City:

State:

Zip Code:

College Status:

• I am a current high school student or first-time JWCC student.
• I am a current JWCC student.

Gender:

Female Male

Race/Ethnic Group:

• American Indian or Alaskan Native
• Asian or Pacific Islander
• Black
• Hispanic
• White
• Non-US Resident

Education

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Scholarships for which you are applying: See Scholarship Directory or visit http://www.jwcc.edu/advancement/scholarships/

List scholarships:

High School Attended:

Year Graduated (expect to graduate):

GPA Recipient:

GPA Recipient

GPA High School / College **:

** If transcripts are not on file at JWCC, please request them to be sent.

What is your intended or declared major?:

Do you plan to pursue a bachelor's degree:

Yes No

JWCC credit hours you will be enrolled in::

For Semester:

Fall Spring

JWCC credit hours currently enrolled:

Financial Status

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Have you completed and submitted the FAFSA (Free Application for Federal Student Aid)? :

Yes No

If you have already been notified of any financial aid you will be awarded, please indicate the amount. and source:

Number of dependents in family:

Annual Income:

Marital Status:

Number or Children/other dependents (if applicable):

Scholarship

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In the space below, give a brief personal statement addressing: your future goals and plans and how your attendance at JWCC will help you meet them, your community activities and special interests, and any other information you wish to have the Scholarship Committee consider. 

Personal Statement:

Please list two references other than family members.

Name 1:

Position 1:

Phone Number 1:

Name 2:

Position 2:

Phone Number 2:

Confirmation

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I have completed this application to the best of my knowledge, and I understand that my application will be incomplete and I will not be considered for any scholarship unless all  high school and/or previous and current college transcripts are submitted (alumni@jwcc.edu).

I also understand that if it is necessary for my financial information to be considered for any JWCCFoundation scholarship, it is my responsibility to complete the FAFSA in a timely manner for scholarship selection.

I agree to attend any function honoring scholarship donors and recipients.

Consent:

I understand and agree to the above statements. I do not agree to the above statement.

reCAPTCHA

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