Educational Information

You must be enrolled in an Occupational Continuing Education credentialing program of at least 96 hours.

Program you are enrolled in:*

Use of Funds (check all that apply):*
TuitionFeesBooksSuppliesCredentialing examsChildcareTransportation

Other Information

Are you a U.S. citizen?*
YesNo

Is anyone in your immediate family a director, employee or family member of an employee of the State Employee's Credit Union (SECU) or the SECU Foundation?*
YesNo

Have you or members of your immediate family worked for or owned a farming or agricultural-related business now or in the past?*
YesNo

Have you or members of your immediate family been employed in traditional industries such as furniture, textiles or tobacco manufacturing?*
YesNo

Has anyone in your household lost their job in the past two years?*
YesNo

Has anyone in your household transitioned from a full-time job to a part-time job?*
YesNo

Have you or members of your family been directly or indirectly affected by Covid-19?*
YesNo

Select one response as it pertains to you, the student:*
Dependent studentIndependent student

Total number of people in your household including yourself:*

Total household income from all sources for 2018:*

Biographical Statement

Write a short essay (50 words or less) about yourself that includes comments on your chosen program of study, how this scholarship will benefit your education and special circumstances you think are important:*

Photo

I will email a photo of myself to samantha_williams33@albemarle.edu.*

Photo Release:*
I, , hereby give COA, the North Carolina Community College System (NCCCS), and the scholarship donor permission to use my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of the donor's activities. I acknowledge that they may be used for any purpose consistent with the organization's education missions.