Dual Credit Need-Based Scholarship Application APPLICANT INSTRUCTIONS: A complete scholarship application must include the additional materials listed below. Incomplete applications will not be considered. 1) A completed UAS Dual Enrollment registration, including Dual Enrollment paperwork and FERPA release(s). 2) UAS Dual Credit Scholarship Student Agreement 3) A typed essay of 300 to 500 words describing how you will benefit from taking dual credit classes. This scholarship will pay tuition for one class (up to four credits). Textbooks, fees, and additional course materials are not included. This scholarship is intended to supplement the existing MEHS-UAS Dual Credit offerings (Welding, Nursing Assistant, Construction Technology, Math or English) so that students can take other courses beyond those MEHS-UAS Dual Credit courses. Other courses students could take through this Scholarship Application may include Psychology, Biology, Business, Art, and more. These should be courses that meet University of Alaska General Education Requirements (GERs), or fulfill core program requirements of one of the UAS Sitka AAS degrees. UAS Sitka Dual Credit Need-Based Scholarship recipients will be eligible to apply for future funding as long as they complete coursework with C or better. Students who do not complete the required coursework or receive a C or better will not be eligible to apply the next term, but may reapply in the future after demonstrating stronger academic readiness. Deadline for Fall application: Early Bird Priority Deadline May 1 Final Application Deadline First day of class Deadline for Spring application: Early Bird Priority Deadline December 1 Final Application Deadline First day of class Deadline for Summer application: Early Bird Priority Deadline April 1 Final Application Deadline First day of class Please submit all application documents to: UAS Sitka Campus ATTN: Scholarship Committee 1332 Seward Avenue Sitka, AK 99835 Phone (907) 747-7771 Fax (907) 747-7793 Email: jwklushkan@alaska.edu 1
Dual Credit Need-Based Scholarship Application Student Name Student Address Date UA ID: City State Zip Code Home Telephone # Cell Phone # Email Current High School GPA Semester enrolling at UAS Sitka (circle one): Fall Spring Summer of 20 HS Class Standing for intended enrollment semester (circle one): Sophomore Junior Senior This scholarship is designed to provide support to low and moderate income students. Check the box next to any assistance program(s) that your household members are receiving. No supporting documentation is required at the time of application, but by indicating services below you are attesting to current benefit status and that you would be able to provide documentation if requested. Head Start Rental Assistance Food Stamps Medicaid Alaska Heating Assistance Program WIC Alaska Weatherization Assistance Program Denali Kid Care Free and Reduced Lunch If none of these apply, then describe your financial situation on page three, question number five. 2
Please tell us a little bit about yourself. 1. What are your current interests? What college degrees or programs are you interested in? (Examples: Business, Nursing, Biology, Law Enforcement, Fisheries, Welding, Education, etc.) 2. Once you graduate high school, what colleges or trade schools are you interested in attending? 3. Please list extra-curricular and volunteer activities, and honors or awards that you have received. 4. What types of training or student services are you interested in receiving from the University? (Examples: Study skills, test-taking strategies, stress management, counseling, career exploration, Federal Student Aid and loans, or understanding credit, etc.) 5. Tell us about anything else that you feel may help the selection committee when evaluating your application. This could include things like your financial situation, your family background, etc. Attach an additional sheet, if necessary, to describe your financial need. I certify that, to the best of my knowledge, all information provided for this scholarship is truthful and correct. Student Signature Date Parent/Guardian Signature Date 3
Dual Credit Scholarship Student Agreement General Information Please read carefully before proceeding The UA system has an open enrollment policy allowing students to register for courses for which they have an adequate background (UA Regents Policy P10.05.010). A complete Dual Credit Scholarship Student Agreement with student, parent/guardian and counselor signatures is required before registration. Enrollment requires completion of Dual Enrollment Registration Form. Students must meet all prerequisites and secure funding to cover tuition, fees, books and materials, unless they apply for and are awarded the UAS Sitka Campus Dual Credit Need-Based Scholarship. This scholarship covers tuition. Students should be prepared to pay for fees, books, and materials. Federal financial aid is not available to students who lack a high school diploma or equivalent. All dual credit earned at the UAS Sitka Campus are college credit, and will be a permanent part of the student s transcript. All students shall conform to the university s academic rules, regulations, and the UA Student Code of Conduct. MEHS student scholarships cannot be applied to pre-existing MEHS-sponsored UAS offerings, which include Welding, Construction Technology, English, or Math. CNA students may apply to receive up to 4 credits of tuition waiver toward the full cost of the course. Additional student-elected dual credit-eligible courses should fill University of Alaska General Education Requirements (GERs) or be core courses in a UAS Sitka AAS program. PART A: TO BE COMPLETED BY STUDENT Student s Name UA ID # Last First M.I Mailing Address Phone number ( ) Date of Birth Last Grade Completed Semester for which student is applying Fall Spring Summer 20 PART B: TO BE COMPLETED BY HIGH SCHOOL COUNSELOR The School Counselor endorses the student enrolling in the following college courses: Name and Signature of Recommending High School Counselor The recommendation of the High School counselor signifies that the student has a High School cumulative GPA of at least 2.5 and/or is in good standing and has the ability and maturity to benefit from college-level instruction. Counselor Name (Please Print) Signature Date 4
PART C: TO BE COMPLETED BY PARENT/GUARDIAN It is important that parents/guardians and minor dual credit students recognize that students are participating in collegelevel coursework within a university environment and that UAS Sitka class enrollment will be representative of the diverse student body, including adults. In order for the minor student to participate their parent/legal guardian must accept the following terms by initialing each. Students must meet with an Academic Advisor to identify appropriate courses and explore the extent to which the student has adequate background to meet expectations of college-level study. Student completes the Dual Enrollment Registration form which includes signatures of student, parent/guardian and UAS advisor. Instructor permission is also sometimes required. Students must complete Education Record Information Release form, required by Federal regulations (FERPA), in order for UAS official to be able to speak to parents/guardians and counselors about the student s academic progress, registration status, accounts and student affairs record. Students are required to attend a brief UAS Dual Credit Student Orientation or the scholarship will not be awarded. All college coursework and grades become a permanent part of the student s official college academic history and transcript. To participate in this program students must have minimum cumulative high school GPA of 2.5, and maintain a GPA of 2.0 (C) in all college coursework. Student must abide by the University of Alaska Student Code of Conduct and Sitka Campus policies. Student is expected to meet all deadlines, assignment expectations, etc. Courses may include frank discussions of sensitive topics of an adult nature. Group work, field trips, and/or class presentations may be expected in the class. If required, these activities and assignments will not be modified to accommodate minors. Student must secure funding to cover tuition, fees, books and materials, unless awarded one of the following dual credit scholarships: UAS Sitka Campus Dual Credit Need-Based Scholarship or the Sitka Tribe Dual Credit Scholarship. Award amounts cover full tuition but may not cover books and fees. Students not awarded a dual credit scholarship are responsible for 100% of the tuition, fees and textbooks at the start of the semester. Student will be reimbursed for 66% of the tuition, after successful completion with a C or higher. Students who do not complete or earn a C or higher will be ineligible to reapply for a scholarship the following semester. The Family Education Rights and Privacy Act (FERPA) is federal law that affords parents and guardians the right to have access to their children s education records, the right to seek to have records amended, and the right to have some control over the disclosure of personal identifiable information from the education records. When a student turns 18 years old, or enters a postsecondary institution at any age, the right under FERPA transfer from the parents to the student ( eligible student ). Although the rights under FERPA have now transferred to the student, a school may disclose information from an eligible student s education records to the parents of the student, without the student s consent, if the student is a dependent for tax purposes. Neither the age of the student nor the parent s status as a custodial parent is relevant. If a student is claimed as dependent by either parent for tax purposes, then either parent may have access under this provision. UAS will not release a student s information to a parent without a signed authorization from the student to release information and proof that a student is claimed as a dependent for tax purpose. Emergency Contact Name(s): elationship: Phone number: ( ) - I certify that I have read and understand the listed responsibilities and expectations outlined on this form for a minor attending the UAS Sitka Campus and approve enrollment in the courses listed on the front of this form. Parent/Guardian Signature Student Signature Date Date 5