Columbus Promise Scholarship Application

Educational/College Information

PLEASE NOTE: This scholarship is specific to CSCC students, students MUST apply and be accepted at CSCC to be considered.
As of today, have you applied for admission at Columbus State Community College? *

Yes No
Are you a College Credit Plus student? *

Yes No
Cougar Web ID: *
If unknown - enter N/A
Where do you plan to live during the 2022-23 academic year? *

With Parent/Guardian Own Apartment
Intended Major *
Begin typing your major to select option. If you are unsure-enter Undecided

Document Uploads

PLEASE NOTE: If you are a US Citizen you must provide a copy of your 2022-23 FAFSA Student Aid Report to be considered for this scholarship.
Please upload a copy of your 2021-22 Unofficial High School transcript. *

Browse Files

Cancel of
Please upload confirmation of CSCC Admission application. *

Browse Files
Ex.. Screenshot of confirmation email from CSCC or confirmation of acceptance email. Cancel of
Please upload the FULL copy of your 2022-23 FAFSA Student Aid Report (SAR).

Browse Files
*This complete document should be 4-5 pages in length. Cancel of

Confirmation & Consent
Authorization to Release FAFSA and FERPA Protected Information

In order to determine eligibility, award and administer Columbus Promise, I Know I Can needs information to be released to us by Columbus State Community College. This form authorizes Columbus State Community College to release this information to us.

The Family Education Rights and Privacy Act of 1974 (FERPA), as amended, affords you certain rights regarding your education records. FERPA generally prohibits schools from releasing education records or certain information contained in such records, such as your grades, billing and payment records, financial aid awards, and other student record information, to third parties. This consent to release records to I Know I Can applies to such records that may otherwise be protected under FERPA.

Institutions may, pursuant to Consolidated Appropriations Act, 2021 [Public Law 116-260] and with explicit written consent from the student, share Free Application for Federal Student Aid (FAFSA) information with a scholarship-granting organization or tribal organization.

CONSENT TO RELEASE INFORMATION

For the purpose of determining eligibility, awarding and administering my scholarship and in support of my academic success, I hereby authorize Columbus State Community College to provide the staff, directors, associates, agents and representatives of I Know I Can with the following information:

· Data collected from my Free Application for Federal Student Aid (FAFSA), including tax return information disclosed under section 6103(l)(13) of the Internal Revenue Code of 1986 with respect to the applicant

· Financial Aid Information (financial aid award letters and notifications, grants, scholarships, other awards, student employment, loans, disbursements and eligibility)

· Student Account Information (bills, statements, charges, credits, balances, payments, past due amounts, collection activity)

· Education Information (grades, courses, credits, GPA, registration, student ID number, academic progress, enrollment status, attendance, communications with advisors and other college staff deemed relevant for the administration of my scholarship)

This information may be used only for the stated purposes and for no other purposes.

I understand and agree that this authorization will remain in effect until the conclusion of my participation in the Columbus Promise or I notify Columbus State Community College and I Know I Can in writing to revoke it. This authorization automatically terminates at the conclusion of my participation in the Columbus Promise.
As of today, are you 18 years old or older? *

Yes No
Student Signature: *

Clear
ONLY if the student is under the age of 18, their parent or legal guardian must also sign below.

My (parent) signature below is my explicit written consent for the disclosure of my legal minor son/daughter/legal dependents above information by Columbus State Community College to the staff, directors, associates, agents and representatives of I Know I Can upon their request.
Parent Signature:

Clear
Date

Month Day Year
Date
Should be Empty:

Columbus Promise Scholarship Application - 2022

Student Information

Parental/Guardian Information

Educational/College Information

Document Uploads

Confirmation & Consent