Personal Information

First Name *

Middle Name

Last Name *

Student ID If you do not have your student ID number yet, leave this blank.

Street Address * Enter your street address.

Mailing Address If you receive mail at a P.O. box.

City *

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

Zip *

County/City of Residence * ... Floyd Giles Montgomery Pulaski Radford Other

Other Location If you selected Other in the previous question, enter your County/City of residence here.

Date of Birth *

Phone Number * Preferably a cell phone.

Email Address *

Emergency Contact Name * Please enter the name of the person we should contact in case of an emergency.

Emergency Contact Number *

Are you a US Citizen * Yes
No

If no, are you a permanent resident? Yes
No

Visa Type

High School State * High School selection will be available after you select a state.
For GED and Home School, select the state you received your GED or Home Schooling, and then select it from the high school list.
... International Armed Forces Americas Armed Forces Europe Alaska Alabama Armed Forces Pacific Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
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High School Graduation Date Month: * ... January February March April May June July August September October November December Year: * ... 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944

Applicant must submit a copy of high school transcript and if applicable, a copy of all college transcripts, (including NRCC transcripts) to the Foundation Office. Your transcripts must be received by the application deadline.

Colleges Attended If you have not attended college yet, please skip this question. College selection will be available after you select states.
College State 1: ... International Armed Forces Americas Armed Forces Europe Alaska Alabama Armed Forces Pacific Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
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College 1: ...
College State 2: ... International Armed Forces Americas Armed Forces Europe Alaska Alabama Armed Forces Pacific Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
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College 2: ...

Are you currently attending NRCC? * Yes
No

What is (or will be) your major plan of study? * If undecided, list a tentative area of study.

What is your proposed future occupation, if known?

Do you plan to earn a two-year degree at NRCC? * Yes
No

Extracurricular Activities High School and/or College. List school, activity, year, offices held

Honors and Awards: High School and/or College Honor: School: Year: ... 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Honor: School: Year: ... 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Honor: School: Year: ... 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Honor: School: Year: ... 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024

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

Financial Information

Marital Status: Single
Separated
Divorced
Married

Number and ages of dependent children Number: Ages: Number of members in household, including yourself Number of members in household who are currently in college, including yourself Total household annual income: Below $25,000
$25,000 - $34,999
$35,000 - $44,999
$45,000 - $54,999
$55,000 - $64,999
$65,000 - $74,999
Above $75,000

Name of parent(s):
Address:
City: State: ... Armed Forces Americas Armed Forces Europe Alaska Alabama Armed Forces Pacific Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip: Number of members in parents' household Number of members in parents' household who are currently in college Parents' combined household annual income: Below $25,000
$25,000 - $34,999
$35,000 - $44,999
$45,000 - $54,999
$55,000 - $64,999
$65,000 - $74,999
Above $75,000

Additional Financial Information Please describe any special circumstances regarding your financial situation that you would like the selection committee to consider.

References

References of two people NOT related to you.
Letters of recommendation are NOT required.

Specific Criteria

Answers to the following questions will not be used in the selection process. The information will be used to match those who receive scholarship awards with specific criteria after all recipients have been chosen. For that reason this section must be completed by all applicants for the application to be complete.

Are you a descendent of a Dublin High School graduate? * Yes
No

If yes, list the person's name and your relationship to them

Do you plan to pursue a degree in music at a four-year university? * Yes
No

Are you or an immediate family member a barber or cosmetologist? * Yes
No

Are you a former student of Pulaski County teacher, Carol Hancock? * Yes
No

Have you been accepted into a nursing program at NRCC? * Selecting "No" will deselect any program selection below.
Yes
No

If so, please select the program in which you were accepted: Associate Degree Nursing Program
Practical Nursing Program

Are you interested in a future career with Law Enforcement? * Yes
No

Do you intend to transfer after graduating from NRCC? * Yes
No

Are you a veteran of the U.S. Armed Forces? * Yes
No

If yes, list branch and dates of service

Are you a first generation college student (first in family to attend college)? * Yes
No

Personal Summary

Please use the following space to tell us about yourself. For example, you might address why you chose NRCC, your educational and career goals and how the scholarship would help you achieve your goals. Include any information about your background, achievements, and needs that you feel will assist the selection committee in its deliberations. The length of your summary should be approximately 250-400 words. Be sure to proofread for correct grammar, usage and spelling.

Personal Summary *

• I certify that I give the NRCC Educational Foundation Office authorization to access my Financial Aid information and transcript information.
• I hereby certify that to the best of my knowledge, the information submitted here is complete and correct, and I fully understand my responsibility in meeting and maintaining the conditions established for the scholarship for which I am applying.