<p> SPOON RIVER COLLEGE/SRC FOUNDATION SPRING 2018 FELLHEIMER Scholarship Application MACOMB CAMPUS STUDENTS ONLY Deadline February 28, 2018</p><p>Please neatly complete all information below. You must also complete or have completed a FAFSA for the 2017-18 academic year. Failure to complete the FAFSA or to fully complete this application will make the applicant ineligible for award.</p><p>PERSONAL DATA Legal Name: (Last First Middle) SRC Student ID # Date of Birth (MM-DD-YYYY) Street Address Email Address City State Zip Code Home Telephone # - - Cell Phone # - - APPLICATION STATUS Applying for the following term (check one) Fall Spring Summer I am a (check one) new SRC student returning SRC student I will be attending (check one) full time (12+ hours) part-time (under 12 hours) I am classified as a (check one) freshman (0-29 hours) sophomore (30+ hours) I received an SRC scholarship in the previous year (check one) yes no I have submitted the FAFSA (check one) yes no If yes, list date submitted I have requested all transcripts be sent to SRC Financial Aid Office or have yes no If yes, date requested transcripts on file at SRC (check one) EDUCATIONAL BACKGROUND Name of High School City, State , Date of Graduation Cumulative GPA on a scale of Name of College City, State . Dates Attended From to Cumulative GPA # of Credit Hours Earned Program of Study I am interested in the following program(s) of study at SRC (i.e. Ag, General Studies, English)</p><p>Please list areas of interest for SRC College Life (e.g. Student Government, Athletics (baseball, softball, golf, cross country), Ag/Livestock Judging, Nursing, Writing/Journalism, Art, Drama, Chorus, Habitat for Humanity, Honors, TRIO, etc.)</p><p>Please comment on any school or community activities you have participated in or any other information you wish for the scholarship committee to consider.</p><p>1 AFFIRMATION</p><p>I have read and understand all criteria and requirements regarding Spoon River College Scholarships and SRC Foundation Scholarships and understand that, if I have left any field on this form blank, it can be grounds for immediate and automatic denial of my application.</p><p>The preceding information I have supplied on this application form is correct. If I receive a scholarship, I understand I must adhere to all requirements for that scholarship. I am not in default on any student loan(s). I also give my permission to Spoon River College to request and obtain any related information that would be pertinent to my application and share my information with committees reviewing applications for scholarships. I allow SRC to publish my name as a scholarship recipient but understand no other personal information will be published. I understand that scholarship awards will first be applied to my SRC account to cover any balance due. I also understand that some awards may be made AFTER a semester begins.</p><p>Student Signature ______Date ______</p><p>Parent Signature for Minor ______Date ______</p><p>Please print and mail/deliver this form to: Spoon River College Student Services Office 208 South Johnson Macomb, IL 61455-2137</p><p>Deadline February 28, 2018</p><p>SRC is an Affirmative Action/Equal Opportunity Employer. It is the policy of Spoon River College to be in full compliance with all federal and state nondiscrimination and equal opportunity laws, orders, and regulations. They will not discriminate against any person because of race, color, religion, national origin, sexual orientation, age, handicap, marital status, or status as a disabled veteran or veteran of Vietnam era in any educational program and activities.</p><p> updated 2/2018</p><p>2</p>