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OFFICE OF THE GOVERNOR CORONAVIRUS SUPPLEMENTAL SCHOLARSHIP 2022 and 2023 VI High School Graduates Only Virgin Islands Board of Education READ THE INSTRUCTIONS-TYPE OR PRINT IN INK DEADLINE SEPTEMBER 30, 2023 1. Last Name (Apellido) First Name (Primero Nombre) Middle Initial (Inicial del Nombre del Medio) Male Female 2. Social Security Number (Número de Seguro Social) 3. Local V.I. Mailing Address (Dirección de Correo Postal Local): Local Physical Address (Dirección Residencial Local): E-mail address: Secondary Email Address: 4. Birth Date (Fecha de Nacimiento) 6. Citizenship Status Alien ID No. (Número de Residencia (Estado de Ciudadanía) Extranjera) 7a. Main Contact Number: (Número de Teléfono Local) 7b. Secondary Contact Number: (Número de Teléfono Cellular) Dos referencias de adultos que residen en las Islas Vírgenes. Uno debe ser un familiar. 8. Emergency Contacts-You must provide two (2) separate adult contacts with V.I. addresses. One must be an immediate family member. Full Name (Nombre Completo) Relationship (Relación) Full Name (Nombre Completo) Relationship (Relación) Mailing Address (Dirección de Correo Postal): City, State, Zip (Ciudad, Estado, Código Postal) Home Phone Number (Número de Teléfono) City, State, Zip (Ciudad, Estado, Código Postal) Home Phone Number (Número de Teléfono) Employer (Nombre del Empleo) Work Phone Number (Número de Teléfono del Trabajo) Employer (Nombre del Empleo) Work Phone Number (Número de Teléfono del Trabajo) - 9. Name of High School Attended ______________________________________ Date of Graduation ______________, 202 (Nombre de Escuela Secundaria) (Fecha de Graduación) 10. Name and Address of Institution of Higher Learning Expected Graduation Date (College or University) (Nombre y Dirección de la Institución de Alto Aprendizaje) (Fecha Prevista de Graduación de la Universidad o Colegio) 11. Major Course of Study (Curso Primario de Estudio) 12. Grade Level and Status for Fall Semester: Full-Time On-Line (Grado y estado para el semestre de otoño ) Tiempo Completo) (Estudio por Internet) 1er año Freshman 13. Please attach a letter describing the economic impact the COVID19 pandemic has had on you or your family financially. 14. Please complete the attached W-9 form. 15. By signing below, you affirm that all the information provided in this application is true and accurate and that you understand the terms and conditions of the scholarship for which you are applying. You further understand that should you not attend college during the required time period, all funds received must be repaid. Signature: ___________________________________________ Date: ________________________________________ St. Thomas Office P.O. BOX 11900 St. Thomas, VI 00801 (340) 774-4546 St. Croix Office financialaid@myviboe.com (340) 772-4144 5. Place of Birth (Lugar de Nacimiento) Mailing Address (Dirección de Correo Postal): INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR THE OFFICE OF THE GOVERNOR CORONAVIRUS SUPPLEMENTAL SCHOLARSHIP TO COMPLETE THE APPLICATION, TYPE OR PRINT IN INK. Numbers 1-15 are to be completed by the student. An official college transcript must be submitted by college students. 1. Enter your full name (last name, then your first name and middle initial). 2. Enter your Social Security Number. (An application without a social security number will be returned) 3. Enter your V.I. local mailing, physical address, and email address. (please note that an email address is required for this application. If you have none, please create one to use for this application.) 4. Enter your birth date. 5. Enter your place of birth. 6. Enter your citizenship status or your alien registration number if applicable. 7. Enter your main daytime phone number and a secondary contact number such as alternate cell phone 8. Enter the names, addresses and telephone numbers of two Virgin Islands emergency contacts. a. The application will be returned if local mailing addresses and telephone numbers are omitted. Preferred contact persons are parents, guardians and adult relatives. (Mentors, pastors, and former teachers and the like are not recommended.) The people you list may be contacted and should know your address at all times. 9. Enter the name of the local high school you attended. a. An official transcript or diploma will be required for high school graduates. 10. Enter the name and address of the institution you will be attending. 11. Enter major course of study. 12. Confirm that you are a high school senior entering college as a freshman in fall 2022 or 2023. 13. Attach a letter describing the economic impact the COVID19 pandemic has had on you or your family financially. 14. Complete the W-9 Form Attached 15. Sign and date to Confirm that you wish to apply for the “Coronavirus Supplemental Scholarship” Eligible Applicants Required Supporting Documents 2022, & 2023 graduates of VI High school, approved Home Education/Home School program, Adult Education, and General Education Development (GED) program.  Acceptance letter  Official high school transcript or Diploma  Pandemic impact letter  Completed W-9 Form This is a one-time scholarship. Website: www.myviboe.com E-mail: financialaid@myviboe.com DEADLINE FOR APPLYING – September 30, 2023 Powered by TCPDF (www.tcpdf.org)