The Northern Neck Baptist Association, Inc.
Application for Relief Scholarship
First Middle Last
Name ________________________________
Home Mailing Address ________________________________________urrent Mailing Address __________________________________________________
Age __ Gender ___ Phone Number ___________________________________
Email Address ______________________
Name of Father/Guardian__________________________________________________
Address__________________________________________________________
Occupation________________________________________________________
Name of Mother/Guardian_______________________
Address __________________________________
Occupation ______________________________________
Number of persons in household where candidate currently resides ____________________________
High School _______________ Class of ________________
Name of College/University __________________________
Address ___________________________________________
Classification ______________________________________
Major __________________ Minor ___________________
G.P.A. ____________ Credit Hours To Date ____________
Expected Date of Graduation ________________________
ID Number ________________________________________
Need For Relief
What is the amount of your request? ________________
What is the purpose of your request? __________________
__________________________________________________
What circumstances caused your need? ________________
__________________________________________________
Whar are the steps you have taken to remedy the financial need? _____________________________________________
__________________________________________________
Your Church___________ Did you ask them for help? _____
Results ___________________________________________
Attach documentation o need {bll, invoice, etc.} _______
_________________________________________________
GPS Requiremetns met {2.0 for Community College/Trade School; 2.5 for 4 year institution}
YES NO
Letter of Recommendation from Pastor/Church Official
Date Rec'd _______________
College/University Information and Permission Form
Department Advisor ________________________________
Telephone _________________ Fax: ______________
Financial Aid Advisor _______________________________ Telephone ________________ Fax: _______________
Student Account Officer ____________________________
Telephone _____________________________________
The Northern Nedk Baptist Association, Inc. and its Commission strive to increase the quality of life for those living in the Northern Neck of Virginia.To this end, initial and relief scholarships are awarded to qualifying students. The student signed below has requested funds for an identified need and an amount for continued attendance at your institution of higher learning.
The signature below gives permission for the designated persons named above of your institution to exchange information with the Scholarship Committee of the Northern Neck Baptist Association, Inc. and its Commissions.
Rev.Paul E. Carter, II, Educational Secretary
804.338.2589
Carole L. Kelley, Secretary, 80.214.1995
Gernard Reed, Member, 804.313.7853
Student Printe Name ______________________________
Student Signature _________________________________
Student ID Number ________________________________ Consider using this space to introduce your page. Just click to add your own content.
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