First Name (required) Last Name (required) Address (required) City (required) County State (required) Zip Code (required) Student ID (required) Southern Email Address (required) Other Email Address (required) Date of Birth (required) Phone Number Did you graduate from high school?YesNo If yes, name of high school? Did you earn a G.E.D.? YesNo Current GPA If first-time student, please attach high school transcript. Are you presently attending Southern West Virginia Community and Technical College?YesNo Are you presently attending another college or university while enrolled and taking classes at Southern?YesNo Please provide a brief statement concerning your college plans. (required) Please list activities, honors, and awards. Please provide a brief statement explaining your financial need. (required) Please provide a list of employment or internships including year. Have you completed and submitted the Free Application for Federal Student Aid (FAFSA) for this academic year? (Southern Foundation Policy states Free Application for Federal Student Aid (FAFSA) completion is required to be eligible) YesNo If no, please submit why. Please list other financial aid/scholarships you will be receiving. Academic Program/Major Expected Graduation Date Please identify which semester you're applying for a scholarship. FallSpringSummer I authorize Southern West Virginia Community and Technical College and the Southern West Virginia Community College Foundation, Inc. to verify all information contained in this application. Any institution, agency, or individual may release information to the College or Foundation for verification purposes. I understand the College and Foundation may release this information for verification and/or publicity purposes. It is my responsibility to inform the Office Institutional Advancement staff of any scholarship, grant, or waiver received by me. Southern West Virginia Community and Technical College is an Equal Opportunity Institution and does not discriminate based on race, sex, pregnancy, age, disability, veteran status, religion, color, or age in admission, employment, or educational programs and activities, nor does it discriminate based on genetic information in employment or employee health benefits. Faculty, staff, students, and applicants are protected from retaliation for making complaints or assisting in discrimination investigations. This nondiscrimination policy also applies to all education programs, to admission, to employment, and to other related activities covered under Title IX, which prohibits sex discrimination in higher education. Southern will take steps to ensure that a lack of English language skills will not be a barrier to admission and participation in the college’s CTC offerings. Auxiliary aids and services are available upon request to individuals with disabilities. Southern West Virginia Community and Technical College also neither affiliates with nor grants recognition to any individual, group, or organization having policies that discriminate based on race, ethnicity, sex, color, creed, religion, age, physical or mental disability, marital or family status, pregnancy, genetic information, veteran status, service in the uniformed services, ancestry, or national origin. Inquiries regarding compliance with any state or federal nondiscrimination law may be addressed to Equal Employment Opportunity Officer and Title IX Coordinator, Ms. Debbie C. Dingess, Chief Human Resources Officer, Southern West Virginia Community and Technical College, 100 College Drive, Logan, WV 25601, 304-896-7408; or Section 504 Coordinator, Ms. Dianna Toler, Director of Student Success, Southern West Virginia Community and Technical College, 100 College Drive, Logan, WV 25601, 304-896-7315. TTY 304-792-7054 may be used to communicate with any office or employee of the College.
