LARAMIE COUNTY COMMUNITY COLLEGE Homeland Security (HSEC) Program Scholarship Application

Student Name

Social Security Number or Student ID Number

Phone Number

Email

Mailing Address

City State ZIP

I am requesting HSEC federal grant scholarship assistance for the following Homeland Security Course:

Course Name Semester Fall Year Spring Course Number Summer

1) I am currently enrolled at (select one): Laramie County Community College Central College Sheridan College Western Wyoming Community College

2) The HSEC Course I am applying for is being offered at (select one): Laramie County Community College Casper College Northwest College Sheridan College Eastern Wyoming College Western Wyoming Community College

3) My Current Major______My Current Cumulative GPA ______

Student Certification: I acknowledge that I have read the scholarship eligibility requirements on the reverse side of this application. I agree that to be considered eligible for the HSEC scholarship program I will comply with all requirements. I understand that failure to comply may result in denial of financial reimbursement

______Student Signature Date of Application College Certification: I certify that the student signing this application: (1) is currently in good academic standing at this college, (2) has a current cumulative GPA of at least 2.5, and (3) will not receive any duplicate funding through the financial aid office for the HSEC course shown on this application.

______Financial Aid Representative Signature Date Mail or bring completed form to: Laramie County Community College -OR- Fax to: 307.432.1604 Homeland Security Program 1400 E. College Drive Cheyenne, WY 82007 Produced by LCCC Public Relations PRS 9606b 9/13 LARAMIE COUNTY COMMUNITY COLLEGE Homeland Security (HSEC) Program Scholarship Eligibility Requirements

1. To be eligible for grant scholarship assistance (reimbursement) for a Homeland Security Course, student:

• Must currently be a declared major or certificate seeking Homeland Security student in good academic standing at a Wyoming community college. • Must currently have a minimum cumulative 2.5 GPA. • Must maintain academic standing and minimum cumulative 2.5 GPA throughout the scholarship semester. • May receive no more than $450 in total grant scholarship assistance (reimbursement) for an approved HSEC Course.  Out-of-state students will receive only an amount equal to in-state tuition and fees, not to exceed the $450 limit. • May receive grant scholarship assistance for only one approved HSEC course per semester. • May request reimbursement limited to actual expenses directly related to the approved HSEC course – tuition, books, lab fees, or online learning fees. • May neither apply for nor receive any duplicate financial assistance from any other source for the approved HSEC course for which they receive grant scholarship assistance.

2. Requirements for students receiving grant fund assistance: • Students desiring scholarship assistance for an approved HSEC Course must submit a completed Scholarship Application Form to the LCCC Homeland Security Program Manager for approval. • Approved students will be notified by mail or email of their acceptance into the scholarship program. • To receive scholarship assistance, approved students must:  Be registered for the approved HSEC Course no later than 5:00 p.m. on the last day of “Late Registration” designated by the college where they are taking the course.  Complete and return the Scholarship Course Agreement to the LCCC HSEC Program Manager by the date indicated on the agreement. • No requests will be accepted or approved after the last day of “Late Registration” regardless of the actual start date of the approved HSEC Course. • Students are responsible for submitting original paid receipts (no copies) for eligible course costs to the LCCC HSEC Program Manager. No reimbursement will be made without original paid receipts. • Students are responsible for obtaining appropriate signatures from their college in the “College Certification” sections of both the application form and the reimbursement request form.

Since the assistance to the student is part of a federal grant administered by the Wyoming Office of Homeland Security, students who do not successfully complete the course with a grade of “C” or better will not be eligible under the federal grant for reimbursement of any fees or costs.

Funding for this program is based upon continued grant funding. This program may be terminated at any time if grant funding, or grant guidance changes.

Any requests for exceptions to any agreements or policies for use of Homeland Security Grant Fund Assistance will be directed to and resolved solely by the LCCC Homeland Security Program Manager.