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Danville Community College
Educational Foundation, Inc.
2017-2018 Scholarship Application

Please refer to the Scholarship Guidelines before completing this form.

Please enter None or N/A when you have no information for a field.


DCC Empl ID:  (If applicable)

Personal Title: (e.g. Mr., Mrs., Miss., etc.)

First Name:

Middle Initial:

Last Name:

Suffix: (e.g. Jr., III, Sr., etc.)

Mailing Address:



Zip Code:

City/County where you live:

How long at this address:

Telephone (include area code): - -


Date of Birth (Month/Day/Year): / /

Were you a member of a household with someone directly employed in or receiving income from a tobacco-related occupation and believe you qualify for the Tobacco Financial Assistance Program? If yes, please complete the Tobacco Financial Assistance Application found on the DCC Education Foundation Scholarship page. Yes No   

*Recipient must be a tobacco farmer, have an immediate family member who was a tobacco farmer, from 1998-2004 or be a former employee of the tobacco processing industry in Virginia as verified by the 1040 Federal tax return or Indemnification Settlement letter. (A copy of either must be submitted with the application.) Immediate family is defined as: spouse, father, mother, step-father, step-mother, son, daughter, brother, sister, grandfather, grandmother, step-grandfather, step-grandmother, father-in-law and mother-in-law.

Are you enrolled in a science, technology, engineering, math, or health curriculum? If yes, please complete the S.T.E.M.-H. Financial Assistance Application found on the DCC Educational Foundation Scholarship Page. Yes No   

To be eligible for DCC Educational Foundation Scholarships, you must complete the Free Application for Federal Student Aid (FAFSA) prior to submitting this application. Information on the FAFSA is available at the DCC Financial Aid Office (855) 844-3634 or on-line at

This is a mandatory requirement.

What is the expected family contribution (EFC) listed on your FAFSA?:


Program of study for which you are currently enrolled at DCC:  
Be Specific. (e.g. First Years Studies, Science, Business Administration, etc.)

Are you entitled to veterans' benefits either on your own or through a parent?   
Yes No    What type of benefits?  

Are you eligible for veterans' rehabilitation benefits?   
Yes No

Are you receiving any type of assistance for tuition and/or books?   
Yes No   If yes, please list:   

During the Fall semester, how many credits do you plan to take at DCC?   
Part-Time (Up to 11) Full-Time (12 or More)

Name of high school:  

Month/Year of graduation:  

High school grade point average:  

Your rank in your graduating class:  

Information is not available because:  

If not a high school graduate, date GED was received (Month/Day/Year):   / /

Do you have a Bachelor's degree?   Yes No

References. (Please name two people, preferably your former teachers and not related to you, and include their telephone numbers):

Are you aware of a DCC scholarship for which you are specifically qualified? If so, please name the scholarship and provide the reason why you should be considered:

ScholarshipJustification - Reason you should be considered

Many scholarships require that you demonstrate your involvement in the community and your leadership ability. If you want your application to be seriously considered by the Review Committee, you must complete this section in grammatically correct, complete, sentences or explain why the statement does not apply to you.

Extracurricular Activities (e.g. Clubs, Sports, Hobbies, Talents, Church, Special Interests):

Community Activities (e.g. God's Storehouse, Red Cross, Salvation Army, etc.):

Accomplishments (Honors received, scholarships won):

Please include a paragraph about yourself, your goals, and your reasons for applying for this scholarship:

Danville Community College does not discriminate on the basis of race, color, age, national origin, sex, or disability in its programs or activities.