Success Corps Scholars Interest Form

Success Corps Scholars Interest Form

Today's Date*

Your First Name*

Your Last Name*

Your Email Address*

Your Phone Number*

What is your age group?*

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What are your interests?*

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How did you hear about Success Corps Scholars?*

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What is the name of the school?

I certify that I have truthfully completed all of the information required for receipt of this award. All information on this form is true and correct to the best of my knowledge. I give permission to LCCC to release information about my financial aid and academic record to the LCCC Foundation Office, Scholarship Donor and the Scholarship Selection Committee. In addition, I understand that if I am selected as a recipient of this award, I may be asked to participate in recognition or appreciation activities of the LCCC Foundation to help ensure continued support of the LCCC Foundation Scholarship Program.

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