Mason County Promise Zone Scholarship Application

Please complete the application below so we can begin planning for enrollment and communicate with West Shore Community College on your behalf! For additional information or questions and terms about the Promise Scholarship, please contact our info@masoncountypromise.org.

Consent Terms and Electronic Release:  

I hereby authorize any school that I am enrolled in that participates in the Promise Zone Scholarship, through its agents and employees, to release any of my financial aid, attendance, demographic and/or academic record information, in whole or in part, to my local Promise Zone Authority/Organization coordinator, or his/her designee, to facilitate the analysis of my scholarship eligibility and the subsequent educational and economic impact of this scholarship. 

As a recipient of a Promise Zone educational scholarship, that award information becomes part of my educational record. By consenting to receive any scholarship amount awarded to me, I agree to allow the release of this information in my educational record to third parties specified under the Family Educational Rights and Privacy Act (FERPA). FERPA affords certain rights to students concerning the privacy of, and access to, their education records. While this form authorizes my school, in conjunction with the local Promise Zone Authority/Organization, to release educational records to third parties, it does not obligate either entity to do so. My school reserves the right to review and respond to requests for release of my educational record on a case-by-case basis. For additional information, I can visit the U.S. Department of Education’s website at www.ed.gov/policy/gen/guid/fpco/ferpa/index.html.

The Promise Zone Scholarship can have several positive impacts on postsecondary enrollment, persistence, degree attainment and overall success in college. To understand these impacts, I authorize my postsecondary academic record information, in whole or in part, to be released back to my local Promise Zone Authority/Organization coordinator, or his/her designee, in adherence to FERPA for analysis to inform and improve the Promise Zone Scholarship program.  

I also authorize my local Promise Zone Authority/Organization to use information regarding my scholarship in promotion of the Promise Zone Scholarship.  The Mason County Promise Zone, and its entities,  may be authorized to use my portrait, picture, photograph, name, voice and/or image on videotape, audiotape or film, or any other reproduction of me and to distribute and/or exchange copies of these to promote the program and the public schools of Mason County.  No compensation is offered in exchange for permission.

This release is authorized starting on the date of the electronic signature on this agreement and after scholarship receipt for statistical purposes. To rescind this Authorization, I understand that I must submit a written notification of rescission to my school.  I will also notify my local Promise Zone Authority/Organization in writing of my decision to rescind my authorization. This rescission would result in the termination of my receipt of the scholarship.

My signature (or that of my parent/guardian if I am under the age of 18) electronically via date stamp indicates that I have read this Authorization to Release Educational Records form and that I authorize the release of educational records as described above.

Required Certifications

I certify that all information submitted in this application is accurate and true.

Yes

I agree to the acceptance terms of the Mason County Promise Scholarship Application.

Yes

I authorize the release of my educational records as required by the terms of the scholarship.

Yes

A limited educational supplies award is available to students who qualify in their first and second year as eligible Promise Scholars. To qualify, please review the requirements in your award letter or on the Promise website. Students should still plan for book and course material costs to be a personal investment.

Yes

Students approved to use the Promise Scholarship will have a maximum of six years from the date of high school graduation, or from the date of issuance of a GED or its equivalent.

Yes

Promise funds may be used to cover a maximum of 72 attempted credits, the equivalent to an Associate’s degree from West Shore Community College

Yes

Students must apply annually and remain eligible for federal aid under West Shore Community College's Student Academic Policy in or to remain eligible for the Promise

Yes

Consent and Signature

I understand that the Mason County Area Promise Zone will be accessing student information from my local school district for the purpose of confirming eligibility to receive the Promise Scholarship. Under conditions specified in the FERPA regulations, 34 CFR Part 99, my school district may non-consensually disclose personally identifiable information from education records in connection with the financial aid for which I have applied or received; and for the purpose of administering the Promise Scholarship student aid program.

I consent

Release and Consent

In addition to receiving and understanding the above information on terms, I also provide consent for all releases and statements above.

Electronic Signature via Date Stamp

Enter your electronic signature below: Please type your full name below (If an applicant is under the age of 18, please enter parent or guardian's name).