Please be aware that new and returning students must be taking their courses at the Middlesex campus of CT State Community College in order to be eligible to receive a scholarship offered through the MxCC Foundation. This includes Middlesex courses being taken in Meriden at Platt High School, and manufacturing courses being taken at Vinal and Wilcox Technical High Schools. Application deadline is March 1, 2026.

Question Title

* 1. Please enter your Banner ID:

Question Title

* 2. Contact Information:

Question Title

* 3. Preferred Phone Number:

Question Title

* 4. Are you currently taking Middlesex courses at Platt in Meriden?

Question Title

* 5. Are you over 25 years of age?

Question Title

* 6. To which gender identity do you most identify?

Question Title

* 7. Are you of Hispanic origin?

Question Title

* 8. Are you a single parent?

Question Title

* 9. Did you become a mother when you were a teenager?

Question Title

* 10. Are you a first-generation student, the first in your family to attend a college or university? 

Question Title

* 11. Were  you born in the United States? 

Question Title

* 12. Have you ever been incarcerated? 

Question Title

* 13. Are you employed by a company that is a member of the Precision Metalforming Association (PMA)?

Question Title

* 14. Please describe any disability or defined barrier you may have (optional).

Question Title

* 15. Please describe any financial barriers you have (optional). 

Question Title

* 16. Program of Study (enter the Associate, Certificate, or other Degree Program you are enrolled in):

Question Title

* 17. What is your career track or goal:

Question Title

* 18. Name of High School (or write home schooled):

Question Title

* 19. High School City/State:

Question Title

* 20. What is your student status. Please select one.

New: I will be attending CT State Middlesex for the first time in the Fall 2026 semester.
Returning: I am currently attending CT State Middlesex at the time of this application and will be returning.
Readmit: I attended CT State Middlesex in the past (2 or more semesters ago) and will return.
Graduating: I will be graduating in Spring 2026 or Summer 2026 and will be transferring to a 4-year institution.

Question Title

* 21. If attending CT State Middlesex in the Fall 2026 semester, will you be:

Question Title

* 22. Which of the following campus based clubs and organizations are you a member of (please check all that apply).

Question Title

* 23. List academic honors, awards, and recognition you have earned in high school, at MxCC/CT State Middlesex, or any other higher education institution:

Question Title

* 24. List community service activities and volunteer work you have been involved in during high school, at MxCC/CT State Middlesex, or any other higher education institution:

Question Title

* 25. Please provide a personal statement (approximately 200 words) describing why you should be considered for a scholarship and what motivates you to succeed.

Question Title

* 26. Please write two - three sentences describing your background, and your career and academic goals.  If you are selected to receive a scholarship, this information will be used to introduce you at the Scholarship Awards Ceremony.

Question Title

* 27. If your first semester at CT State Community College is Spring 2026, please check a box below to confirm that you have or will ask all of your current instructors to a complete an electronic mid-term grade report. If you have a CT State Community College transcript, you do not need your instructors to submit mid-term grade reports.

Question Title

* 28. Through the submission of this application, I certify that all information provided is true and accurate to the best of my knowledge. I grant permission to CT State Middlesex, Middlesex Community College Foundation, Inc., and the MxCC Foundation Scholarship Selection Committee to review my transcript(s) and use the information provided in this application for review, recruitment, and public recognition. I agree that the application and all related materials become the property of the MxCC Foundation upon submission. If awarded a scholarship, I release to the College, the Foundation, and the Scholarship Donor, the right to use my name and photograph for publications, reports, and news releases.

By typing my first and last name, I am signing this application, I agree that, if I am selected to receive a scholarship, I will complete a thank you card/note to the donor of my scholarship. I will deliver the thank you card/note to the MxCC Foundation mail slot, Founders Hall mailroom, by May 1, 2026, or will send it electronically to Stacey Burgess at stacey.burgess@ctstate.edu. I also agree that, if I am selected to receive a scholarship, I will pay it forward by volunteering a few hours of my time to assist at upcoming fundraising events or other Foundation and CT State Middlesex events.

Page1 / 1
 
 100% of survey complete.

T