Spelling... Last Name First Name * EPCC Student ID # Date of Birth Mailing Address City State ZIP/Postal Code Telephone Number * Alternate Telephone Number Email Address Gender * Major * Which major do you plan to declare, or currently pursue at EPCC? Student Type * Reception Attendance * A scholarship reception will be hosted during the spring/summer semester (s). Students who receive a scholarship will be contacted and requested to attend. The recipient, along with one guest of choice, will be complimentary.  If you do not attend the reception, you may deemed ineligible to receive a scholarship, unless you have extenuating circumstances that will prevent you from attending. <br/><br/> If you receive a scholarship do you agree to attend a reception? Photo Publication Agreement * If your photo is taken at a scholarship related event/reception or institutional event, do you authorize publication of the picture/audio? Correctness Certification * I certify that the information on this application is complete and correct and understand that the submission of false information is grounds for rejection of my application and withdrawal of offer(s)? Information Release Permission * I hereby give permission for this information to be released to the donor or potential donors of any scholarship. Furthermore, I authorize the publication of any award I may receive. Transcript Permission * I grant permission for an Administrator to obtain an unofficial transcript. Attachments