Last Name
First
Address
City
State Ohio Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone Number (740/389-1212)
Email address
Social Security No. (121-12-1212)
Academic Curriculum Select One Business Engineering General Health Information Technology Public Services
Have you attended MTC under another name? No Yes If yes, give that name:
Are you a high school graduate (or GED)? No Yes
Please mark only the aid for which you may qualify and wish to apply:
Concurrent Scholarship (currently in high school)
MTC Scholarship (GPA 2.5 or higher)
For which term do you wish to use the scholarship:
Fall
Spring
Summer
By checking this box, I hereby release my photo and information to be used in any way to promote the college, scholarships and the Marion Technical College Foundation.
I certify that the information which I have provided is correct. Furthermore, I certify that I am not in default on any Title IV loan made for attendance at any institution and do not owe a refund on any Title IV grant received for attendance at any institution. If I am applying for a scholarship, I give my permission for the Financial Aid Office to review my academic record.
Signature: Date: 00/00/0000
Marion Technical College provides equal opportunities regardless of race, color, national origin, sex, disability, age, military status, or sexual orientation.