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.

1.Please enter your Banner ID:

*2.Contact Information:(Required.)

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address (your @ctstate.edu email) *

*3.Preferred Phone Number:(Required.)

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

Yes

No

*5.Are you over 25 years of age?(Required.)

Yes

No

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

Male

Female

Prefer not to answer

Other (please specify)

*7.Are you of Hispanic origin?(Required.)

Yes

No

8.Are you a single parent?

Yes

No

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

Yes

No

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

Yes

No

11.Were  you born in the United States? 

Yes

No

12.Have you ever been incarcerated? 

Yes

No

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

Yes

No

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

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

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

Accounting Degree or Certificate Advanced Manufacturing Machine Technology Option 2 Degree or CertificateArt Studies DegreeAudio & Music Production Degree or CertificateBiochemistry StudiesBiology Studies DegreeBiotechnology CertificateBiotechnology DegreeBusiness Administration Degree or CertificateBusiness Studies DegreeChemistry Studies DegreeChild, Family, & Community Studies DegreeClinical Coding CertificateCommunication Studies DegreeComputed Tomography Post-Primary CertificationComputer Engineering Technology DegreeComputer Networking Degree or CertificateComputer Programming Degree or CertificateComputer Science Studies DegreeCorporate Media Production Degree or CertificateCriminal Justice DegreeCriminology Studies DegreeDigital Marketing Degree or CertificateDigital Media Production CertificateEarly Childhood Education CertificateEarly Childhood Education DegreeEarly Childhood Education Transfer Track DegreeEconomics Studies DegreeEngineering Science DegreeEnglish Studies DegreeEntrepreneurship Degree or CertificateFilm & Video Production Degree or CertificateFinance Degree or CertificateFrench Studies DegreeGeneral Studies DegreeGeography Studies DegreeGerontology CertificateHealth Care Administration DegreeHealth Career PathwaysHealth Information Technology-Data Management DegreeHistory Studies DegreeHuman Services DegreeHuman Services Management DegreeItalian Studies DegreeIT Support CertificateJournalism DegreeJuvenile Justice DegreeLaw Enforcement DegreeLiberal Arts & Sciences DegreesMagnetic Resonance Imaging (MRI) Post-Primary CertificationMammography Post-Primary CertificationManagement Degree or CertificateManagement Information Systems DegreeManufacturing Engineering Technology DegreeMarketing Degree or CertificateMathematics Studies DegreeMedia Production DegreeMedical Billing & Outpatient Coding CertificateMental Health Degree or CertificateMultimedia Design Degree or CertificateMusic Industry DegreeNews & Sports Production Degree or CertificateOphthalmic Design & Dispensing DegreeOutpatient Medical Coding & Auditing DegreePhysics Studies DegreePolitical Science Studies DegreePsychology Studies DegreeRadiography DegreeSocial Work Studies DegreeSociology Studies DegreeSpanish Studies DegreeTechnology Studies DegreeTheatre Studies DegreeTherapeutic Recreation CertificateVeterinary Technology DegreeVictimology DegreeVisual Art DegreeWeb Design & Development Degree or CertificateOther (please specify)

*17.What is your career track or goal:(Required.)

Dentistry or Related4 year or Bachelor's DegreeVeterinary Technician or RelatedSocial Work or RelatedEngineering or RelatedRadiologic Technologist/Radiology or RelatedPolitics/Government or RelatedJournalism or RelatedComputer Science/ Web Design /Software/Cyber Security or RelatedNursing APRN or RelatedDigital Media/ Film Video Production or RelatedOptician or RelatedMedical Records, Billing, Health Information Management or RelatedUndecidedAccounting/Business Correction Officer/Criminal Justice/Police or RelatedOther (please specify):

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

*19.High School City/State:(Required.)

City/Town

State/Province

*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.(Required.)

New ReturningReadmitGraduating - Spring 2026Graduating - Summer 2026

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

Full-time (12 or more credits)3⁄4 time (9 – 11 credits)Part-time (6 - 8 credits)I am not attending CT State Middlesex in the Fall, but I am transferring to a 4-year institution.

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

Black Student Association (BSA)

Business Club

Computer Club

Gaming Club

Grand Risers Club

Math Club

Organization of Latin American Students (OLAS)

Phi Theta Kappa

Radio Podcast Club

SPEAK

Sports Club

Student Senate

Vet Tech Club

Other (please specify)

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

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:

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

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.

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.

True

False

*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.(Required.)

Name

Date

Send me a copy of my responses via email

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