Scholar Application Form

Personal Details

Name

First

Last

Email

Birthday

Phone

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent or Guardian

First

Last

Parent or Guardian Daytime Phone

Are you a first generation college student?

Yes
No

Do you live with a disability?

Yes
No

Are you a veteran?

Yes
No

U.S. Citizen

Yes
No

If yes...where?

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Academic Background

County School You Attend

Year You Attended

Highschool Details

Highschool Name

Graduating Year

Cumulative GPA

Scholarship Applying For

The schools I have applied to (only if applying for College Assistance Scholarship)

What are your career goals?

What do you plan to do after graduating? What are your career goals?

Community/School Activities

Name of Activity “Key Club”, “Football Team”, “Church Choir”

Activity Type

Grades Participated

Hours/Years and Accomplishments

“e.g. Volunteered 3 hours a week for 2 years. Organized events and became team leader.”

ACT/SAT Details

Composite ACT Score

SAT Score (if taken)

Additional Details

Do you plan on completing your degree with our school?

Yes
No

Have you ever received a scholarship from our school?

Yes
No

Are you planning to major in science, technology

Yes
No

Would you like to be considered for work study opportunities?

Yes
No

Are you planning to major in science, technology (copy)

Yes
No

Essay

Your essay should be 500 words or less.

Explain how and why you want to be a part of the transportation construction industry and what you gained from CCD.

Upload Certified High School Transcript and 3 Recommendation Letters

Drag & Drop Files, Choose Files to Upload

Name of Recommendation Person - Relationship / Time Known - Daytime Phone Number

Your Signature

Clear Signature

Signature and Submission Applicant's Email (as signature)

Date Signed

Signature and Submission Applicant's Email (as signature)

Parent Email (as signature)

Parent, Guardian, or School Official Email (as signature)

Signature Date

Date (Parent/Guardian/School Official Signature Date)