CEED 201170 Opportunity Grant Application 5 21 10 by iKj66k7


									                                                                               Office use only
                                                                               Date received________________ Initials________
                                                                               Application approved      Yes           No
                                                                               Student I.D. number
                                                                               Date _____________________ Initials ________
CEED Opportunity Grant Application                                                 Two weeks or more before start date
                                                                                   20% Date is on __ __ / __ __ / __ __
FY2011 (Fill in all fields and attach documents.)
                                                                                   20% Date has passed
Section 1: Completed by student (and parent/guardian if
student is a dependent)
Date ______________________________
Student’s Name _______________________________________________                Home phone # ________________
Address ____________________________________ City/State/Zip ___________________________________
Date of birth _____________               Term:      Winter___    Spring___     Summer____           Fall_________
Certification student is pursuing__________________________________________________________________
Non-credit courses in which student is currently enrolled or will enroll (include course number)_______________
Family Information (family income)
Number of household members including applicant ___________________________________________________
Number of family members in college including applicant ______________________________________________
Gross yearly income student (and parents if dependent) from 2009 tax form_________________________
Other unreported income student (and parent(s) if dependent) ____________________________________________
Other financial aid or payment of tuition you receive_____________________________________________
Required Documents
   1. Completed scholarship application
   2. Federal tax forms – 2009 tax forms or W-2s. If the applicant is of dependant filing status, include parent's
        or guardian's tax forms
   3. Other supporting documents (ex: child support, social services, social security benefits)
   4. A separate statement explaining extenuating family circumstances may be attached.
Student signature ___________________________________________________ Date ____________________
Parent or guardian signature __________________________________________ Date ___________________
       (if student is a dependent)

Section II: Send to
Promptly mail or deliver the fully completed grant application with supporting documents to the address below:
Kathleen S. de Wit, Director of Administration
Division of Continuing Education & Economic Development
The Community College of Baltimore County, V Building
800 S. Rolling Road
Baltimore, Maryland 21228

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