Rouse Scholarship Application

Rouse Scholars Logo

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are required.

Part I: General Information

First Name /sebin/w/m/navigate_right.gif

Last Name

Middle Name

Address

2nd line Address

City

State

Zip Code

Day Telephone Number

Evening Telephone Number

Cell Phone Number

E-Mail Address

Social Security Number

Gender

Age

2010 Family Income

Anticipated 2011 Family Income

Household Size

Anticipated or Declared Learning Program at HCC

Part II: Essay

James W. Rouse Scholars Program scholarships are awarded based on one or more factors, including academic achievements and goals, financial need, extracurricular activities, work experience and others. Please attach a word doument containing a brief essay explaining how and why a scholarship would enable you to achieve your goals. You may also highlight any academic interests and achievements, fi nancial need, and/or special circumstances you would like the scholarship committee to consider. Additional pages may be attached if necessary. (Please place your name and Social Security number on each additional page.)

Upload Essay (Word Document)

Part III: Certification of Accuracy

Please read and enter your full name in the box below to affirm this statement.

I certify that the information contained in my scholarship application is true and correct. I give Financial Aid Services permission to release my name, address, telephone number, learning program, GPA and essay to the HCC Educational Foundation to share with the scholarship donor(s).

Signature

Part IV: Submit Application