Page ContentGeneral Instructions for Applicant:Please read and review the HBCU/MSI Scholarship Program Overview.All application materials should be submitted electronically.Your application is the first impression you will make upon those who award scholarships. Please check for spelling, grammar and clarity.It will take approximately one hour to complete this application. It must be completed in one sitting. A save and complete later function is not available.You are advised to save your written statements in a separate document, then copy/paste the text into the corresponding text boxes in the Application Statements in this form.To complete this application you will need:Unofficial university transcriptResumeOne letter of recommendation HBCU Scholarship Program Application Form * I agree I have read the scholarship program overview. Required 2023-2024 Academic Year Applicant Form * Indicates required field (Click the Reset button at the bottom of the form to clear all form fields) * Full Name: Required Preferred Name: * Current Mailing Address: (where you receive U.S. Postal Mail) Required * City: Required * State: North Carolina Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico U.S. Virgin Islands Northern Mariana Islands Guam American Samoa Palau * ZIP: Required Permanent Mailing Address: Permanent City: Permanent State: North Carolina Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico U.S. Virgin Islands Northern Mariana Islands Guam American Samoa Palau Permanent ZIP: * Date of Birth: Invalid Date Format. Please enter valid date, ex. MM/DD/YYYY * Phone (Include area code): Invalid Phone Format. Please enter a valid phone number, ex. 999-999-9999 Indicate your classification status and completed credit hours as of May 2023: Classification: Undergraduate Graduate Please select a radio button for classification. Credit Hours Completed: Please select a radio button for year. Are you a full-time student? Yes No Please select a radio button for full time student status. Are you a U.S. citizen? Yes No Please select a radio button for U.S. Citizenship. If no, please attach a CERTIFIED copy of Certificate of Eligibility (SEVIS I-20) or Permanent Resident Card (Form I-551) issued by the C.I.S. Gender: -- Select -- Male Female Non-binary Prefer not to disclose Race/Ethnicity (optional): -- Optional -- African/African American (Non-Hispanic or Latino) Alaskan Native American Indian Asian Hispanic or Latino Native Hawaiian/Other Pacific Islander Two or More Races (Non-Hispanic or Latino) White (Non-Hispanic or Latino) Other Experience Experience in Other Transportation Education Programs: ENO Fellow - Yr. National Summer Transportation Institute - Yr. Dwight David Eisenhower Transportation Fellowship Program - Yr. University Transportation Centers Award - Yr. Summer Transportation Internship Program for Diverse Groups - Yr. Have you previously participated in a NCDOT Office of HBCU Outreach Program? Check all that apply: HBCU/MSI Fellowship Program HBCU/MSI Internship Program HBCU/MSI Scholarship Program National Summer Transportation Institute Education * College/University (must be a North Carolina HBCU/MSI): -- Select -- Bennett College Chowan University Elizabeth City State University Fayetteville State University Johnson & Wales University - Charlotte Johnson C. Smith University Livingstone College North Carolina A&T State University North Carolina Central University North Carolina Wesleyan College Saint Augustine's University Shaw University University of North Carolina at Pembroke Winston-Salem State University * Current GPA: Required * Expected Graduation Date: Required * Applicant's Major: Required * Applicant's Field of Study (i.e., Traffic Studies, Physical Planning): Required Application Statements Note: You are advised to save your written statements in a separate document, then copy/paste the text into the corresponding text boxes below. * Personal Statement Describe how your education will prepare you for a career in transportation. This personal statement should include relevant background and future goals. (Limit 1,000 words) Required * Financial Statement Describe how this scholarship will assist you in matriculating through your HBCU/MSI. Include pertinent information that gives a general overview of your financial need. Please share your cost of attendance including, but not limited to, the following: tuition, room, books and fees. Include all additional scholarships and financial support you are receiving. (Limit 1,000 words) Required IMPORTANT NOTE: Once you press the submit button you will not be able to return to this application. This application does not have a save and return mechanism. You can only apply once. Upload Requirements: All files must be selected at the same time - Upload all files at once How to select multiple files to upload: Store all files for upload in the same folder on your computer Click Browse button and navigate to the folder where the files are stored For individual files: Hold down the Ctrl key and click individual file(s) for upload For a group of files: Click the first file you want to select, hold down the Shift key and click the last file you want After you release the Ctrl or Shift key, click the Open button Uploads are limited to a maximum of nine files Uploads are limited to a maximum upload size of 25MB By submitting this application, I certify to the statements contained in this document and that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious or fraudulent statements or claims may subject me to criminal, civil or administrative penalties and your scholarship will be rescinded. Please enter your name, email address and upload an unofficial transcript and resume, as well as complete the recommendation form. * Name: Required * Email Address: Please enter a valid email address, ex. name@example.com. Upload Files: If you need assistance with this form, please contact the Office of HBCU Outreach. Validating Fields Submitting Form Submit Reset 11/21/2022 3:49 PM