Win a $1000 Scholarship to HCTC!

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WYMT and Hazard Community & Technical College want to give you a $1000 scholarship. Simply fill out the form below to be resistered. We will be contacting the winner by phone or e-mail so make sure both of these items are correct. Please register before August 1st.

Please visit www.hazard.kctcs.edu for more information about HCTC.

1.Contact Info:

First Name*		M.I.		Last Name*

Email Address*		Daytime Phone*		Evening Phone

2.Address

Street Line 1*

Street Line 2

City*

State*

Zip Code*

3.I would like more information about HCTC.*

Yes

4.Please enter your date of birth.

Month*		Day*		Year*


	5.Terms and Conditions

	YES, I have read, understand, and agree to the Web site usage agreement and privacy policy.


	* represents required fields Children under the age of 13 may not submit this form.

Rules:

The scholarship is non-transferrable.

The scholarship will be awarded in two installments: $500 for the 2008 Fall Semester and $500 for the 2009 Spring Semester.

The scholarship can be used at any of the HCTC locations, Hazard, Hyden, Hindman and Jackson.

The winner will be randomly selected on August 1st.