APPLICATION FOR NCPHA CHILD OF MEMBER SCHOLARSHIP - CHECK THE WEBSITE FOR APPLICATION DEADLINE

CHILD NAME: ______

ADDRESS: ______

EMAIL ADDRESS: ______PHONE: ______

Parent Information

NCPHA Member Parent/Parents Name(s): ______

If more than one parent is member, you may select one, or include information for both.

Parent(s) current member(s) of NCPHA: yes___ or no____ Current membership is required to apply.

Parent(s) place of employment & employer address: ______

Parent work phone______

Academic Program Information

I am  attending or  plan to attend ______

(Name of Institution)

In the program/major ______

(Name of Program)

Degree or certification sought: ______

Accepted into institution:  yes, full-time  yes, part-time  application under consideration  not yet applied

Dates of current or planned enrollment: ______Expected date of completion: ______

Financial Need

Anticipated Cost of Education per Year (or for the certification): ______

Please indicate how you plan to meet this educational expense (other than with this scholarship) including the type and amount of other financial aid you have available or for which you are applying.

______

Reasons for requesting scholarship: ______

Personal Statement and Future Plans

In one typed page, tell us about any extracurricular activities (in and out of school) and your plans after graduation.

(Attach to application)

Application checklist – please indicate if the following REQUIRED items are enclosed or being sent separately.
·  Personal Statement and Future Plans (one typed page)  enclosed
·  Two letters of recommendation
Recommender 1: ______ enclosed  being sent separately
Recommender 2: ______ enclosed  being sent separately
·  Official High School or College Transcript  enclosed  being sent separately
·  Proof of acceptance, enrollment, or application to academic institution/program listed above  enclosed  being sent separately / MAIL TO:
NCPHA Scholarship Committee
222 N. Person Street, Suite 208
Raleigh, NC 27601

I certify that my application is truthful and complete.

______

Signature Date