Virginia Tobacco Scholarship Application Packet (Page 2 of 4) in pdf

Application for 2016-2017 Virginia Tobacco Settlement Program

The purpose of the Southwest Virginia Community College Tobacco Scholarship Program is to provide tuition assistance to certain

persons who are now or were formerly associated with the tobacco industry. This scholarship program is designed as a “last dollar”

program after all other tuition assistance has been exhausted. Recipients must be in an approved program leading to a degree or

certificate and priority will be given to full time students. To be eligible a student must be a former tobacco quota owner, a former

tobacco producer, a former tobacco grower or a family member of the previously mentioned categories. Student must complete the

required scholarship application and the Free Application for Federal Student Aid (FAFSA), prior to being considered for tobacco

funds.

Priority will be given to students full time (12-14 credits)

Funds will pay tuition only. No books or supplies will be covered.

Students need to be working towards a degree or certificate to be eligible.

Awards will be made on the condition of availability of funds.

You must complete the FAFSA prior to being considered.

Name __________________________ Tobacco Farm Location (County) __________

Address _______________________________________________________________

City ___________________________________ State _____ Zip __________

Social Security Number_________________Birthdate_____________Telephone____________

Please check and complete each of the following categories that apply to you:

___ I am a Virginia resident and former tobacco quota owner or family member.

___ I am a Virginia resident and former tobacco producer or family member.

___ I am a Virginia resident and former tobacco grower or family member.

If you are a family member or worker, list the name and address of the producer or quota owner.

Name ________________________ Tobacco Farm Location (County) ____________

Address ________________________________________________________________

City _______________ State _____

Zip _______ Telephone _____________________

Student’s Relationship to quota owner/producer (check one):

___Self

___Spouse

___Child

___Grandchild

___Son/Daughter In-Law

Number of family members in your household: _________

Number of household members planning to attend any College in 2016-2017 academic year at least ½ time. ____

I currently plan to enroll: (circle all that apply) _____ Summer 2016

___ Fall 2016

___ Spring 2017

I am interested in the following program(s):

_________________________________

I have applied for federal financial aid at SWCC _______________

I plan to apply for federal financial aid _________________

I certify that I am currently a Virginia resident meeting all eligibility requirements stated above and that the above information is true

and subject to verification. I understand that I will be required to repay any funds disbursed to me if it is later determined that I have

provided incorrect information.

__________________________________

____________

Applicant Signature

Date

Virginia Tobacco Scholarship Application Packet Page 2

Related Articles

Related forms

Related Categories