Michael J. Brown Application Please complete the application below. Name First Middle Last LCCC Student Number * RequiredAddress Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email Number of Total College Credits Earnedif applicableCurrent GPAProvide a brief profile of yourselfSpeaking directly to at least some of the criteria listed on the The Michael J. Brown Discovery Scholarship & Learning Community webpage.What are your educational and career goals?How are you funding your college education? Please reference other scholarships or aid you are receiving.Participation in this learning community requires participation in programs and activities such as: a leadership class, community Service, internships, reading groups, field trips, working with faculty mentors, networking with local leaders, trips to local conferences, and volunteering). Please state your interest in these activities and give some indication of how you will fit them into your schedule.I certify that I have truthfully completed all of the information required for receipt of this award. All information on this form is true and correct to the best of my knowledge. I give permission to LCCC to release information about my financial aid and academic record to the LCCC Foundation Office, Scholarship Donor and the Scholarship Selection Committee. In addition, I understand that if I am selected as a recipient of this award, I may be asked to participate in recognition or appreciation activities of the LCCC Foundation to help ensure continued support of the LCCC Foundation Scholarship Program.Signature * RequiredDate * Required MM DD YYYY
