Leland Scholarship Form
Leland Scholarship Form
Date______________
To see a complete list of scholarships, click HEREMasters ____ Location: Arlington ____ Hampton Roads ____
Diploma ____ Location: Arlington ____ Hampton Roads ____ Mineral ____ Richmond ____ Other ____
1. Name__________________________________________ Last four digits of SS#_____________
2. Address____________________________________________ Email ________________________________________
3. Church Membership__________________________________________ City __________________ State _________________
4. Citizenship_________________________________ Ethnicity______________________________
5. Credit Hours completed ( as of June 30) _________ Anticipated Graduation date_______________
6. Planned Credit Hours during next 12 months Fall _____ January _____ Spring _____ June _____
7. Current GPA _______________
8. Amount you are requesting: _________________________
9. If needs based, complete #10 Financial Data, otherwise skip to #11.
List the estimated amounts of financial assistance you will
receive during the scholarship period from the following
sources.
Source
Amount
Other
Scholarships:
Name:
______________________
$_________________________
Name:
______________________
$_________________________
Name:
______________________
$_________________________
Name:
______________________
$_________________________
Government
Grants:
______________________
$_________________________
Parents, spouse, savings,
etc.:______________________
$_________________________
Employment
income:
______________________
$_________________________
Loans:
______________________
$_________________________
Total:
______________________
$_________________________
11. Scholarships for which you qualify and wish to be considered. Descriptions and qualifications for the scholarships may be found at the link at the top of this form.