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Terri Quam To select multiple items, hold control or command and click each one.
Have you completed the 2021-2022 FAFSA?
Have you ever participated in a Mesa Community College study abroad program before?
If you answered YES to the previous question, indicate which study abroad program you participated in and in what year.
Have you signed a 2019-2020 Men's Baseball NJCAA Letter of Intent?
I understand that whether or NOT Federal Student Aid and/or scholarships are awarded, I am responsible for payment of all study abroad program fees by April 1, 2022. All scholarship funds will automatically be applied to your outstanding balance after your summer term begins. Funds cannot be issued prior to the official disbursement date regardless of your study abroad departure date. Failure to pay the debt may result in any or all of the following: 1) My debt may be turned over to a collection agency and/or attorney. 2) I may be reported delinquent to the credit bureau. 3) My state tax refund WILL be offset by the amount of debt.
If you have a high school diploma or GED, indicate the month and year you graduated or obtained your GED.
What is your Cumulative Grade Point Average?
Have you ever participated in a Mesa Community College study abroad program before?
Are you a current participant or graduate of the Maricopa Hoop of Learning Program? Yes
No
Are you returning to college following an interruption of your education?
Are you currently enrolled at Mesa Community College?
What is your educational plan?
Briefly explain any volunteer service that may pertain to your field of study or has otherwise impacted your community.
Are you first or second season participant?
I will complete the program in accordance with program guidelines and the Mesa Community College Student Code of Conduct. I will positively represent Mesa Community College throughout my participation in the program.
Are you working on your first Associates or Bachelors Degree?
Are you a first or second season participant?
Are you a graduate of a Mesa School District?
I understand that whether or NOT Federal Student Aid and/or scholarships are awarded, I am responsible for payment of all study abroad program fees by April 1, 2022. All scholarship funds will automatically be applied to your outstanding balance after your summer term begins. Funds cannot be issued prior to the official disbursement date regardless of your study abroad departure date. Failure to pay the debt may result in any or all of the following: 1) My debt may be turned over to a collection agency and/or attorney. 2) I may be reported delinquent to the credit bureau. 3) My state tax refund WILL be offset by the amount of debt.
What is your Cumulative Grade Point Average (GPA)?
What are your Cumulative Credit Hours?
Please list the performance ensembles you were registered for in Fall 2017 and those that your are currently registered for in Spring 2018. Also list any additional playing you do for Mesa Community College or any production work you do for the Choral, Instrumental or Music Theatre programs.
Why do you want to attend this trip?
List any expenses and amounts of those expenses you might have incurred as a music major, such as; accompanying fees, music purchase, dance shoes, etc.
Are you a graduate of a high school in the state of Arizona or hold a GED diploma?
Are you a Surprise Resident, city staffer, or Luke AFB Personnel?
What year did you receive your High School Diploma or GED? Answer what year you received your High School or GED, if you have neither just answer n/a
Do you receive scholarships, financial aid, or any type of tuition assitance?
Have you signed a 2018-2019 Women's Softball NJCAA Letter of Intent?
Have you signed a 2015-2016 Women's Track and Field NJCAA Letter of Intent?
Have you signed a 2016-2017 Men's Soccer NJCAA Letter of Intent at Glendale Community College?
Have you signed a 2018-2019 Women's Soccer NJCAA Letter of Intent?
Are you currently enrolled in the second block of the nursing program?
Do you have a documented disability?
What is your cumulative Grade Point Average (GPA)?
If you answered YES to the previous question, indicate which study abroad program you participated in and in what year. Example: Xalapa, Mexico in 2013
Have you been enrolled in at least one semester with Mesa Community College?
Have you signed a 2017-2018 Volleyball NJCAA Letter of Intent?
If I am awarded a scholarship and/or grant and fail to maintain a passing grade in my study abroad program, I understand that I may be asked to return any MCCCD scholarship or grant funds that I have been awarded.
Do you work or did you work or volunteer during high school?
Will you work at all while you go to school? What will you do?
Are you currently meeting Satisfactory Academic Progress? Students must successfully complete 2/3 (66.67%) of all attempted course work.
The Nina Mason Pulliam Legacy Scholars Program is available to individuals who meet at least one of the following eligibility criteria; please check all that apply to you: Students ages 18-25 who have been raised through the foster care system and have no form of financial support
College-age youth and adults with physical disabilities
Adults who are 25 years or older who have dependents in their family units To select multiple items, hold control or command and click each one. Child Welfare System
For the purposes of this scholarship program, Child Welfare System is described as the public-supported system that serves neglected, abused, abandoned, at-risk children and/or those who are wards of the courts. A person who has experienced time in the child welfare system may have lived in an institution such as a group home, child protection agency, or special facility for children, and/or with a foster family. This applies particularly to those persons who were raised away from their biological parents or relative caregivers for extended periods of time, were financially supported by sources other than their families, and are presently responsible for themselves financially. This does not include applicants and/or their biological parents receiving TANF, food stamps, or other state aid such as AHCCCS that are not foster youth.
Physical Disabilities
A physical disability for the purposes of this scholarship program is one that limits or impairs a person's ability to access and/or be fully mobile on campus, and/or creates a special challenge for classroom instruction, tutoring, student support services, participation in campus offerings, and other academic and extracurricular activities. This includes disabilities that substantially limit major life activities such as walking, seeing, hearing, speaking, breathing, writing and working. These disabilities
may be results of, but not limited to, spinal cord injuries, brain injuries, speech impairments, visual impairments, hearing impairments, epilepsy, cerebral palsy, multiple sclerosis, muscular dystrophy, loss of limbs, and severe orthopedic injuries. Applicants are to provide official documentation of their physical disability from a medical or health care provider.
Adults with Dependents
These are adults who are 25 years of age or older and have dependents in their family units (self not included). These adults may be first-time college students or returning students (those with previous college experience). The family unit may include relatives or other persons who may live in or outside the applicant's household for whom the Internal Revenue Service has
determined there is a financially dependent relationship.
Are you working toward your first college degree?
What is your ethnicity? American Indian/Alaska Native
Asian
Black or African American
Hispanic/Latino
Native Hawaiian or other Pacific Islander
White
Have you participated in student clubs and organizations, ASMCC, leadership retreats, co-curricular programs, and/or volunteered on campus.
Have you signed a 2018-2019 Men's Track and Field NJCAA Letter of Intent?
Are you a United States citizen?
Are you an Arizona resident, as determined by the admissions and records office?
Demonstrate your community service in this application.
Are you physically disabled?
Which program will you be majoring in?
If physically disabled, what is the nature of your disability? If you are not physically disabled, please answer "Not applicable".
Please list the ages of your dependents. If you do not have any dependents, please answer, "Not applicable".
In what state were you in foster care/ward of the court? If you have not been in the foster care system or were a ward of the court, please answer, "Not applicable".
Are you a legal resident of Maricopa County?
What is your marital status? Single
Married
Divorced/Separated
Widowed
What is your gross annual household income?
Do you have any means of support other than your household income? If yes, please explain and give an approximate dollar amount.
What is your citizenship status?
Are you enrolled at Mesa Community College?
How many credits are you enrolled in for Spring 2019?
Have you completed an Individual Education Completion Plan (IECP) for your current degree at MCC? The scholarship review committee requests a copy of your Individual Education Completion Plan (IECP) during the scholarship review process. The IECP is completed with the help of an academic advisor.
How many credits are you enrolled in for Fall 2018?
What are your educational plans for the Spring 2019 term?
Are you an alumni that actively participated in the ACE (Achieving College Education) Program at Mesa Community College?
What are your long term educational or career goals?
Have you met with your mentor at least three times this semester?
Are you strongly motivated to establish and maintain a mentoring relationship?
If engineering what field?
What is your College Cumulative GPA?
Which MCCCD college or campus are you planning to attend in Summer? Chandler-Gilbert Comm College
Estrella Mountain Comm College
GateWay Community College
Glendale Community College
Mesa Community College
Paradise Valley Comm College
Phoenix College
Rio Salado College
Scottsdale Community College
South Mountain Comm College To select multiple items, hold control or command and click each one.
For the purposes of this application, a single parent is defined as the sole provider and caretaker for one or more dependents under the age of 18. Are you a single parent?
Are you currently pursuing an Associate Degree in Applied Science (AAS) in Exercise Science and Personal Training or a Certificate of Completion as a Personal Training Specialist.
Do you have a mimimum cumulative GPA of 2.5?
Provide the name (s) of your current ( and past, as appropiate) C4S mentor.
Have you completed a 2018-2019 FAFSA application?
Have you completed the Study Abroad Ireland 2019 online application?
What College / University are you currently attending? Answer this question based on the institution you are currently attending as of the date of this application.
Are you or will you be part of a club activity on your campus?
Are you part of the Maricopa-ASU Pathways Program (MAPP) transfer program to ASU?
Are you actively participating in the Connect 4 Success program? Active participation will be verified with C4S program coordinator.
Do you qualify for a Maricopa Community College District (MCCD) faculty, staff or dependent tuition waiver?
Are you a current participant or graduate of the Maricopa ACE (Achieving a College Education) Program?
Which of the following is your primary campus?
I hereby authorize Mesa Community College Cashier Services to pay the following program with my current financial aid and/or scholarship:
Have you completed a 2021-2022 Free Application for Federal Student Aid (FAFSA)?
Are you currently a player on the SCC baseball team.
Which MCCCD college or campus are you planning to attend in Spring ? Chandler-Gilbert Comm College
Estrella Mountain Comm College
GateWay Community College
Glendale Community College
Mesa Community College
Paradise Valley Comm College
Phoenix College
Rio Salado College
Scottsdale Community College
South Mountain Comm College
Institution (MCCCD College or Campus Attending) Chandler-Gilbert Comm College
Estrella Mountain Comm College
GateWay Community College
Glendale Community College
Mesa Community College
Paradise Valley Comm College
Phoenix College
Rio Salado College
Scottsdale Community College
South Mountain Comm College
Are you majoring in an MCC Business and Information Systems department program? These include: General Business, Real Estate, Computer Information Systems, Web Technology, Networking, and other areas
What College/ University are you currently attending? Answer the question based on your current enrollment status as of the date of this application.
I will complete the program in accordance with program guidelines and the Mesa Community College Student Code of Conduct. I will positively represent Mesa Community College throughout my participation in the program.
I certify that the information provided is accurate and correct to the best of my knowledge.
I authorize the Maricopa Community Colleges to release any necessary information to the International Education Office, donor and or Maricopa Community Colleges Foundation, as such entity may require.
Please select one of the options below that best describes your current enrollment status for the study abroad program at Mesa Community College.
Are you currently attending high school? Answer the question as of today.
If you have a high school diploma or GED, indicate the month and year you graduated or obtained your GED. Example: May 2011 (05/2011)
I hereby authorize Mesa Community College Cashier Services to pay the following incurred expenses for study abroad program fees from my financial aid grants, loans, and/or scholarship awards. All fees (tuition, fees, supplies, study abroad program fees, or other).
Certification Agreement After my return, I will write a testimonial about my experience and what I gained from my experience and submit it to the Mesa Community Study Abroad Coordinator.
What do you want to do when you graduate from college?
From what high school did you graduate? Provide name and address of high school you graduated from.
Have you completed more than 24 college level credits? (In order to qualify for this scholarship, applicants must not have more than 24 college level credits) College level credits are 100 level or above courses and can be applied towards an Associate degree. Developmental courses (i.e. MAT082, RDG081, ENG091) are not considered college level credits. In order to qualify for this scholarship, applicants cannot have completed more than 24 college level credits.
College level credits are 100 level or above courses and can be applied towards an Associate degree. Developmental courses (i.e. MAT082, RDG081, ENG091) are not considered college level credits.
How did you hear about the Nina Mason Pulliam Legacy Scholarship Program?
Briefly explain your career goals within the field of Administration of Justice.
Do you require auxiliary aids or services related to your disability? If you do not require any aids or services, please answer, "No".
If you are not physically disabled, please answer, "Not applicable".
Have you ever been under the care of the child welfare system (foster care) or been a ward of the court? For the purposes of this scholarship program, Child Welfare System is described as the public-supported system that serves neglected, abused, abandoned, at-risk children and/or those who are wards of the courts. A person who has experienced time in the child welfare system may have lived in an institution such as a group home, child protection agency, or special facility for children, and/or with a foster family. This applies particularly to those persons who were raised away from their biological parents or relative caregivers for extended periods of time, were financially supported by sources other than their families, and are presently responsible for themselves financially. This does not include applicants and/or their biological parents receiving TANF, food stamps, or other state aid such as AHCCCS.
Are you admitted to the Mesa Community College Nursing Program?
Is your current enrollment equal to or greater than 9 credits (according to current MCC Nursing Department criteria)?
Have you signed a 2018-2019 Men's Soccer NJCAA Letter of Intent at Mesa Community College?
Select the option that best describes the four events you attended. Option 1: Four Workshops - Four completed workshops from Connect 4 Success, Financial Aid, Career Services, Counseling, Learning Enhancement Center, and/or MesaCan (A New Leaf). Alternative workshop(s) must be pre-approved by a Connect 4 Success staff member.
Option 2: Four Tutoring Center Visits - Four visits each semester at a minimum of one hour per visit to an MCC tutoring site such as Learning Enhancement Center, Math & English Tutoring Centers, and/or Academic Skills Center. Alternative tutoring sites must be pre-approved by a Connect 4 Success staff member.
Option 3: Combination of four events - Attend workshops and tutoring center visits that equal 4 events at a minimum of one hour per event. Must attend a minimum of four events (select one option below):
Option 1: Four Workshops - Four completed workshops from Connect 4 Success, Financial Aid, Career Services, Counseling, Learning Enhancement Center, and/or MesaCan (A New Leaf). Alternative workshop(s) must be pre-approved by a Connect 4 Success staff member.
Option 2: Four Tutoring Center Visits - Four visits each semester at a minimum of one hour per visit to an MCC tutoring site such as Learning Enhancement Center, Math & English Tutoring Centers, and/or Academic Skills Center. Alternative tutoring sites must be pre-approved by a Connect 4 Success staff member.
Option 3: Combination of four events - Attend workshops and tutoring center visits that equal 4 events at a minimum of one hour per event.
Are you currently enrolled full -time (12 or more hours) at Mesa Community College?
Have you completed at least one PHILOSOPHY or RELIGIOUS STUDIES course at Mesa Community College?
Which MCCCD college or campus are you planning to attend in Fall? Chandler-Gilbert Comm College
Estrella Mountain Comm College
GateWay Community College
Glendale Community College
Mesa Community College
Paradise Valley Comm College
Phoenix College
Rio Salado College
Scottsdale Community College
South Mountain Comm College
I certify that the information provided is correct to the best of my knowledge. I understand that consent is given to Mesa Community College to release academic, financial, or any other necessary information to assist the Scholarship Committee in making its selection. All information is confidential and will only be used to assist in the selection process.
What professional certification will you be seeking? American Council on Exercise (ACE)
National Strength and Conditioning Association (NSCA)
National Academy of Sports Medicine (NASM)
The American College of Sports Medicine (ACSM)
Why is it important to learn more about the Southwest and its cultures?
How do you intend to make positive impacts on this trip?
Can you commit to meeting an assigned Mentor in person (face to face) on campus for a minimum of three (3) times?
Have you signed a 2018-2019 Women's Basketball NJCAA Letter of Intent?
Have you completed an application to the England, France, and Scotland Study Abroad Program at Mesa Community College?
Have you completed the 2020-2021 FAFSA?
Are you in Block 4 of the Nursing Program?
