UTBC Student Information & Scholarship Interest Form

UTBC Student Information & Scholarship Interest Form

Please complete all sections below to provide your information and indicate your scholarship interests.
Student Information

Please provide your personal details.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Current Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Current Grade or Status*
Parent/Guardian Information

Please provide parent or guardian contact details.
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Scholarship of Interest

Select the scholarships you are interested in and provide required information for eligibility.
Willie F. Wilson ScholarshipVernon E. Hawkins ScholarshipRev. Mary L. Wilson ScholarshipRev. Anika Wilson-Brown ScholarshipScholarship in Honor of Jerry Spense, Davon Pitchford, Derrick McKelvin
High School SophmoreHigh School JuniorGraduating High School SeniorGED Recipient
Yes, 2-Year InstitutionYes, 4-Year InstitutionYes, Trade SchoolNo
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