You must have JavaScript enabled to use this form. Required fields are marked with an asterisk '*'. Name * First * Middle Last * Email * Phone * Home Address * Address * City/Town * State/Province * - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ZIP/Postal Code * Have you lived in North Carolina for over 1 year (and have documentation to demonstrate you are a NC resident)? * Yes No Not Sure Are you a United States citizen? * Yes No What is your visa/immigration status? Are you currently working with young children? Yes No Please provide the name of the center or school where you work. Are you a current or former student at A-B Tech? Yes No Please provide your student ID number (if you remember it). Have you previously taken EDU-119 and passed with grade of A, B, or C? Yes No If you have taken any other EDU courses, please list the courses you have completed with a grade of A, B, or C. When do you anticipate being able to start the 2-semester scholarship program? January 2027 Some time later If you participate in the program, would you need a laptop computer? Yes No Please tell us how you learned of this scholarship opportunity Director/Supervisor Program Flyer Outreach from A-B Tech Coworker or friend Other