CE-Golden Leaf Community College Scholarship Application

2024-25 Golden LEAF Foundation Application
Eligible students must reside in a rural county that is tobacco dependent, or economically distressed, as determined by the Golden LEAF Foundation (see list for approved counties)
Personal Information
Full Name*
Student ID Number
Email Address*
Phone Number
Address*

Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NC County of Residence*
To be eligible for an initial award, your permanent residence must be in a qualifying county determined by Golden Leaf.
How long have you lived in the county listed *
Educational Information
WCE Course/Pathway you are enrolled/enrolling in:
WCE student must be enrolled in a credentialing program that is at least 96 hours.
Other Information
Have members of your immediate family worked for or owned a farming or agricultural related business?*
Have you or members of your immediate family been employed in traditional industries such as furniture, textiles, or tobacco manufacturing?*
Has anyone in your household lost their job in the past two years?*
Has anyone in your household transitioned from a full-time job to a part-time job?*
NOTE: To be eligible for this scholarship, students must demonstrate need. For curriculum students, completion of the Free Application for Federal Student aid (FAFSA) is required.
Applicant Certification

By signing this, I agree that I have read and understand the requirements of this scholarship. I hereby declare that the information provided on this form is complete and correct to the best of my knowledge.
Applicant Signature: Signature* Time
Date

MonthDayYear
Date
Wilson Community College Marketing Release:

By signing below, I give permission for my photograph, video, and/or written statements to be used for marketing purposes by Wilson Community College if awarded this scholarship.
Approval Signature: Signature*:Time
Date

MonthDayYear
Date
Should be Empty:

2024-25 Golden LEAF Foundation Application

Personal Information

Educational Information

Other Information

Applicant Certification

Wilson Community College Marketing Release: