A. Personal Information

Student ID: (7-digit number, i.e. "0123456")

Birth Date:

Gender: Male Female

First Name:

Middle Name:

Last Name:

Address:

City:

State: State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

County: County All Other Boone De Kalb McHenry Ogle Stephenson Winnebago

Home Phone:

Cell Phone:

Email:

I would like to be considered for: (check all that apply)
Program-based scholarships Merit-based scholarships (new high school students and new adult students with 6 or less RVC credits must include high school or other college transcripts or GED scores) Need-based scholarships (must complete the financial aid information)

Briefly describe what it will mean to you, your family and your community if you should receive an RVC Foundation private donor scholarship.

B. Student Information

Note: You must select exactly one of the following student types:

High School Student

New Adult Student

Returning Adult Student

C. Education Plans

My education plans at Rock Valley College:

I plan on attending full-time (12+ credit hours)
I can only attend part-time (less than 12 credit hours)

My intention at RVC is to (select one):

Please write a brief statement about your education and career goals.

D. Financial Need

Note: Only complete this information if you wish to qualify for a need-based scholarship.

Financial Aid Information

The RVC Foundation through its private donor scholarships offers a maximum award amount of $1,500 per year, or $750 per semester. This is not enough to cover tuition, books, and fees. How will you pay for your remaining education costs?

E. Scholarship Criteria

Many RVC Foundation Scholarships have a secondary set of preferred criteria that a donor would like to see met if at all possible. Some of this criteria can already be determined, such as living in a particular county, or graduating from a particular high school. Completing this section is not required, but it can improve your chances of receiving a scholarship.

Individual Preferences (check all that apply):

Returning student who once dropped out of college

Single parent

One or both of my parents have a bachelor's degree or higher

Veteran, or a member of my immediate family is a veteran
          Relationship:     Branch of Service:

Direct descendant of a Korean War veteran (documentation needed)
          Relationship:     Branch of Service:

I have a documented disability:  

Firefighter's Local 413 member or member's immediate family

Area Firefigher, but not member of Local 413

RVC Preferences (check all that apply):

RVC student worker, department:

Involved in RVC activities:

Involved in RVC intercollegiate athletics, sport:

Member of the RVC Fitness Lab

Studying economics, and have a letter of recommendation from an RVC Economics instructor

I am taking music lessons at RVC

I am in a vocal or instrumental ensemble at RVC

Photography:       As a career       As a hobby

Community Preferences (check all that apply):

I have participated on my high school/college/community newspaper
          Name of publication:

I am involved in community activities
          Activities:

I have been a team leader or manager
          Where:

F. Certification

I certify that the information on this form and all attached documentation is true and complete to the best of my knowledge.

I understand that by signing and submitting this scholarship application and supporting documents, I waive my rights to the Family Education Rights and Privacy Act (FERPA) for the purposes of selection and for providing recipient information to the donors of any scholarships I may be awarded. I also understand that my directory information and quotes from my application and submitted documentation may be used in publications, reports, press releases, etc. I addition, I give Rock Valley College permission to release my student education information to the Rock Valley College Foundation for the purpose of awarding and administering scholarships.

I further acknowledge that I will supply official transcripts and/or other required information to either the Rock Valley College Financial Aid Office or the RVC Foundation by the scholarship application deadline. I am aware that failure to do so may eliminate me for consideration of any scholarship awards that I may otherwise qualify for.

Applicant's Full Legal Name as Signature:

Submit Finished Application