Scholarship Application Form - Southern State Community College

Southern State Community College

Scholarship Application Form

**Please print, complete, and send to the Financial Aid Office at the address listed below.

Read the scholarship descriptions on this form and select the one for which you are applying. (In this case, you will select Pommert Foundation)
Attach copies of your SAT and ACT, scores if available.
Attach your high school transcript and request previous colleges to forward copies of your transcripts listing grade point averages and class rank the the address shown below.
Attach a letter of recommendation from a teacher or counselor, or other recommendations as necessary and forward to the address shown below.

Office of Student Financial Aid
Southern State Community College
100 Hobart Drive
Hillsboro, OH 45133

*Incomplete applications may not be considered for scholarships.

Priority deadline is March 15.

Student Information

Last Name First Name MI

Telephone Social Security Number

Birthdate Street Address

City State Zip Code County

Indicate the type(s) of scholarships for which you qualify:

TRUSTEE

Academic Excellence

Valedictorian/Salutatorian

Departmental: Accounting Agriculture Business

Computer Science Early Childhood Education

Education Engineering Human Services

Math/Science Medical Assisting Nursing

Performing Arts Visual Arts

TECH PREP

Tech Prep

FOUNDATION

Foundation Scholars Bennett Foundation Daniels Foundation Hodson Foundation

Igo Foundation Jacobson Foundation Pommert Foundation Seipelt Foundation

OTHER

High School Information

High School Name

School Street Address

City State Zip Code County

Rank/Number In Class GPA Date of Graduation

Indicate SSCC Program Major

Associate of Arts Associate of Science

Associate of Applied Business

Accounting Business Management Computer Programming

Office Information Real Estate

Associate of Applied Science

Agriculture Production Computer Assisted Design Computer Technology

Corrections Drafting Design Early Childhood Education

Electrical/Electronics Emergency Medical Services

Human and Social Services Law Enforcement Medical Assisting

Nursing

Associate of Technical Studies

Other Colleges Attended

College Name Dates Attended

Major Degree

College Name Dates Attended

Major Degree

Activities

List school and community activities, honors earned and offices held below.

Work Experiences

List present and previous employers, dates of employment, and a brief job description for each.

Personal Statement

Use this space to provide information about career goals, background, and any other information which would assist the committee in judging eligibility for a scholarship. If you wish to be considered for a specific scholarship, please provide information pertaining to that scholarship.

Certification

I authorize the release of all information to the Scholarship Committee. If I am awarded a scholarship, I agree to abide to all conditions of the scholarship and I give permission to Southern State Community College to release information to any appropriate agency.

Applicant's Signature Date

**Please print for submission.