HCC Foundation Workforce Scholarship Application
Please note: After submitting your application you will see a confirmation page. If you do not receive a confirmation page, your application has NOT been submitted. No changes will be accepted after submission.
Questions that require an answer are marked with  *
Please complete this application fully and honestly. Providing false information will disqualify you from receiving an HCC Foundation scholarship. Also, please check the spelling of your contact information prior to submitting.
1. Personal Information
* First Name:
Middle Name (if applicable):
* Last Name:
* Student ID or Social Security Number:
* Street Address (please include apartment number if applicable):
* City:
* State:
* County: NOTE: Do not list a Country for your answer.
* Zip Code:
* Preferred Phone Number (###) ###-####:
Cell Phone (###) ###-####:
Work Phone (###) ###-####:
HCC Email Address:
* Personal Email Address:
* Number of Dependents (not including yourself):
* Birthdate: (This is to assist in identification in the HCC Student Administration system and not utilized for scholarship selection)
* Gender:
* Ethnicity:
* Family income: Please indicate, for the most recent tax year, your family's gross income. Include both untaxed and taxed income.
* Household size: How many people, including yourself, live in your household?
* Citizenship:
* What is your military status?
* Are you an HCC employee or a dependent of an HCC employee?
If you are a dependent of an HCC employee, what is that person's name?
What is your relationship to the HCC employee named above?
2. Educational Background
* Did your father and/or mother complete college with a degree or certificate?
* High school last attended/currently attending:
* High School City:
* High School State:
* High School County:
* Select the option that best describes your current educational level:
* What month and year did you graduate or receive your GED? If you have not yet graduated, what is your anticipated graduation month/year?
 Please enter a date:
3. HCC History and Academic Plan
* Please indicate your status for the Fall 2014 semester:
* What is your HCC educational plan?
* What is your HCC major?
* Which HCC College will you attend in Fall 2014 / Spring 2015? If you will attend more than one, please select the college where you will take the most hours.
* HCC completion date:
 Date you expect to complete your courses at HCC:
* How many hours will you take in Fall 2014? All scholarships require you to take a minimum of 6 credit hours (usually at least two classes). Some require you to take 9 or 12 hours.
* How many hours will you take in Spring 2015?
* Will you be attending HCC as a member of the Honors College?
4. Character, Community Service, and Leadership
* Community Service. Have you been involved in community service or volunteer activities? NOTE: If you select Yes and the following questions are not completed, your answer will automatically be changed to No.
If Yes, please provide a name and contact number of someone who can verify your community service.
 Name of community service organization 1:
 Name of contact at community service organization 1:
 Phone number of contact 1:
 Name of community service organization 2:
 Name of contact at community service organization 2:
 Phone number of contact 2:
Employment History. List your last two jobs, beginning with the most recent:
Employer One
 Name of Employer:
 Dates Employed (mm/yy - mm/yy):
 City of Employer:
 State of Employer:
 Phone Number of Employer:
Employer Two
 Name of Employer:
 Dates Employed (mm/yy - mm/yy):
 City of Employer:
 State of Employer:
 Phone Number of Employer:
References. Please list the names and phone numbers of two references who know you personally, are NOT members of your family, and can comment on your goals and character. NOTE: Failure to answer will result in the nullification of your application.
* Reference One
 Phone Number:
* Reference Two
 Phone Number:
Membership in Professional Organizations/Societies & HCC Student Activites. Please list below any organizations, societies, or activities of which you are a member.
Awards and Honors. Please list below any awards and honors you have received.
5. Financial Status
* Have you completed a FAFSA (Free Application for Federal Student Aid) application?
If your answer was "no," please choose one of the following:
If for any reason you cannot provide any of the information requested, or had difficulties with this application, please explain below. Otherwise you may leave this field blank. Do not list additional information you want considered here.
7. Certification
* I hereby certify that all the information contained in this application is true and correct, and I release to the HCC Foundation any educational or other records necessary for the processing of this application.
Please print a copy of this application prior to submitting. Once you submit your application, no changes or additions will be possible. Review your application carefully.

If you do not see a confirmation page, your application has not been submitted.
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Phone: 713-718-8595 | Fax: 713-718-8631