Overview

Scholarship Application

Please fill-out and submit the application below. You will be contacted by an MCC representative regarding next steps. Please note that income verification is required as part of the application process.

Please note that submission of this form does not guarantee a scholarship award.

First Name

Middle Initial

Last Name

Date of Birth

Street Address City State Zip Mobile Phone Email

City of Rochester resident?

Yes

US Citizen or Permanent Resident?

Yes

NY State Resident for past 12 months?

Yes

Unemployed?

Yes

Proof of unemployment status is required as part of the application process.

Current Employer Job Title

Current salary range (if applicable)

$0 - $51,999

$52,000 or higher

You will need to provide your most recent paystub in order to be considered for funding.

Highest level of education completed:

Desired Program(s):

Start Date

I certify that the information I provided as part of this application is true and correct to the best of my knowledge. I give consent to the sponsoring organization considering this application to use the information provided herein, for the purpose of scholarship consideration.

All fields must be filled out completely.

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