Name *

First Name

Last Name

Home/Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Birthdate *

MM

DD

YYYY

Parent/Guardian Name(s)

(if under the age 18)

First Name

Last Name

Parent/Guardian Address

(if under the age of 18)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone

(###)

###

####

High School Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of High School Graduation *

(or anticipated graduation)

MM

DD

YYYY

Additional Application Requirements Checklist *

Below is a list of additional application requirements to be completed. Please obtain and prepare the following documents and email them in one email to terrirausch@yahoo.com. Select the information you will be sending.

Letter of acceptance from your academic/vocational institution

A letter of recommendation from a teacher, coach, or mentor

Letter from a physician, certifying diagnosis

An official transcript from your high school and an acceptance letter or confirmation of enrollment from your academic/vocational institution (for first year students)

An official transcript from your college/university (for current college students)

Application Certification *

I certify that the information presented in my application is accurate and complete. I understand and agree that any inaccurate information, misleading information, or omission will be cause for the invalidation of any grant offered to me. NF Michigan may verify any, and all parts of my application materials. If NF Michigan awards me a scholarship, I give permission to publicize my name and brief biographical information. I also understand that it will be necessary to provide a current digital photo of myself for to NF Michigan, if I am selected as a recipient.

I have read and accept