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Golden LEAF Scholars Program | Corporate & Continuing Education
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Foundation Events
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Golden LEAF Scholars Program | Corporate & Continuing Education
Personal Information:
Name
(Required)
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Last
Suffix
Mailing Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email Address
(Required)
Enter Email
Confirm Email
Phone Number
(Required)
NC County of Residence
(Required)
ALAMANCE
ALEXANDER
ALLEGHANY
ANSON
ASHE
AVERY
BEAUFORT
BERTIE
BLADEN
BRUNSWICK
BURKE
CALDWELL
CAMDEN
CASWELL
CATAWBA
CHEROKEE
CHOWAN
CLAY
CLEVELAND
COLUMBUS
CRAVEN
CUMBERLAND
DARE
DAVIDSON
DAVIE
DUPLIN
EDGECOMBE
FRANKLIN
GASTON
GATES
GRAHAM
GRANVILLE
GREENE
HALIFAX
HARNETT
HERTFORD
HOKE
HYDE
JACKSON
JONES
LEE
LENOIR
MACON
MADISON
MARTIN
MCDOWELL
MITCHELL
MONTGOMERY
NASH
NORTHAMPTON
ONSLOW
PAMLICO
PASQUOTANK
PERQUIMANS
PERSON
PITT
POLK
RANDOLPH
RICHMOND
ROBESON
ROCKINGHAM
ROWAN
RUTHERFORD
SAMPSON
SCOTLAND
STANLY
STOKES
SURRY
SWAIN
TRANSYLVANIA
TYRRELL
VANCE
WARREN
WASHINGTON
WAYNE
WILKES
WILSON
YADKIN
YANCEY
Note: Only residents from specific counties are eligible for this award. If your county is not listed, please do not select another county as an alternate.
Length of Residence in County:
(Required)
Less than 5 years
5-10 years
More than 10 years
Educational Information:
I am enrolled or plan to enroll as an Occupational Continuing Education Student.
(Required)
Yes
No
The program must be at least 96 hours long.
I am enrolled or plan to enroll into the following program:
(Required)
Automotive Collision Repair
Airframe & Powerplant
Advanced Commercial/Residential Electrical Wiring – Spanish
Basic Commercial / Residential Electrical Wiring - Spanish
Basic Construction Technology
Basic Residential/Commercial Building Framing (Eng. &Span)
Building ConstructionInterior/Exterior Finish (Eng. &Span)
Commercial Solar Construction
Drawings / Blueprint Reading (Electrical, Building, Plumbing & HVAC) (Eng. &Span)
Electrical Lineman
Intro Commercial / Residential Electrical Wiring - Spanish
Intermediate Commercial / Residential Electrical Wiring - Spanish
Solar Technician
Window, Doors & Trim Installation (English & Spanish)
EMT-Initial
Cardiovascular Monitor Technician
Certified Nursing Assistant I
Certified Nursing Assistant II
Paramedic Initial
Patient Care Technician
Phlebotomy
Registered Medical Assistant I
Registered Medical Assistant II
Certified Personal Trainer NASM®
Electronic Health Records Office Professional Online
FTCC Online Medical Administrative Assistant Online
FTCC Medical ICD-10 Coding Part I Online
FTCC Medical ICD-10 Coding Part II Online
FTCC Online Medical Billing Online
FTCC Online Working in the Pharmacy Online
Health Information Technology Part I Online
Health Information Technology Part II Online
Medical Billing (Intermediate) Online
Medical ICD-10 Coding & Billing Part I Hybrid
Medical ICD-10 Coding & Billing Part II Hybrid
Physical Therapy Office Professional Online
Professional Medical Coding & Billing Part I Online
Professional Medical Coding & Billing Part II Online
Therapeutic Massage
Working In the Pharmacy Part I Online
Working In the Pharmacy Part II Online
Army Welding (Military Personnel Only)
Certified Production Technician (Military Personnel Only)
Industrial Welding Technology
Mobile Welding (Welding Generator / Gas and Propane - English & Spanish)
Pipe / Structural Welding (Pipe Welding Exam)
Pipe / Structural Welding (Structural Welding)
Upholstery Sewing
Cisco CCNA Certification
CompTIA A+ Network+ Security++
CompTIA A+
Computer Technician Online
Commercial Truck Driver
Heavy Equipment Operator Backhoe and Skid Steer (English & Spanish)
Other Information:
Have members of your immediate family worked for or owned a farming or agricultural related business now or in the past?
(Required)
Yes
No
Have you or members of your immediate family been employed in traditional industries such as furniture, textiles, or tobacco manufacturing?
(Required)
Yes
No
Has anyone in your household lost their job in the past two years?
(Required)
Yes
No
Has anyone in your household transitioned from a full-time job to a part-time job?
(Required)
Yes
No
Please list all campus and community service activities you are currently involved in.
(Required)
Use of Funds:
Select the category or categories you are requesting funding for.
(Required)
Tuition
Fees
Books
Supplies
Credentialing Exams
*Childcare
*Transportation
Select All
Consent for Application
(Required)
I have read and understand the requirements for assistance. I hereby declare that the information provided on this form is complete and correct to the best of my knowledge.
Additional Consent
*Students using funds for childcare and / or transportation purposes are asked to consent to the additional statement(s) below.
Use of Childcare Funds Statement
If selected for funding from the Golden LEAF Scholars Program - Two-Year Colleges, I certify that scholarship funds designated for childcare will be used exclusively while I am attending class in order to fulfill my educational requirements.
Use of Transportation Funds Statement
If selected for funding from the Golden LEAF Scholars Program - Two-Year Colleges, I certify that scholarship funds designated for transportation will be used exclusively for the purpose of supporting my travel to and from the college where I am enrolled for educational purposes.
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