Application for Students Who Did Not Obtain a High School ...

Application for Students Who Did Not Obtain a High School Diploma from a Public or Private High School (Homeschooled Graduates)

ELIGIBILITY REQUIREMENTS FOR STUDENTS WHO DID NOT OBTAIN A HIGH SCHOOL DIPLOMA FROM A PUBLIC OR PRIVATE SCHOOL* Homeschooled students must meet all of the following requirements to qualify for the Governor Guinn Millennium Scholarship:

1. Would have graduated from high school after May 1, 2000 had the student been enrolled in high school. 2. Receive an enhanced ACT composite score of 21 or higher or a combined reading and math SAT score of 990 or higher (if the student took the SAT

test before March 2016). If the student took the SAT on or after March 2016, the student needs to obtain a combined reading, math and writing SAT score of 1070 or higher (Test date should be reflective of when the student would have been enrolled in high school). 3. Establish residency by providing evidence that the student has been a resident of the State of Nevada for at least two years of the student's normal (4) years of high school attendance. A dependent student may also establish residency if the parent or legal guardian has been a resident of Nevada for the required two-year period. 4. Achieved at least a 3.25 weighted or unweighted GPA in all courses completed in a Nevada High School.

(Nevada High School Proficiency exam scores are required for students who graduated or would have graduated prior to 2017. Applications must be submitted within the limitations established in Title 4, Chapter 18, Section 9.1.3 for the student's normal year of HS graduation)

SECTION I-Student Information Please complete the following information about yourself, the person applying for the Governor Guinn Millennium Scholarship (GGMS).

STUDENT INFORMATION Mr. Mrs. Miss Ms.

Last, First, M.I.

Date of birth (mm/dd/yyyy)

Telephone number PERMANENT ADDRESS

Email address

Number and street, including apartment number

City PHYSICAL ADDRESS (If different than the permanent address)

State

Zip Code

County

Number and street, including apartment number

City

State

Zip Code

SECTION II-Requirements* Had you remained in a public or private high school, what year would you have graduated?

Did you complete any high school courses in a Nevada public or private high school? Yes No

If yes, please enclose a copy of your sealed official high school transcript and complete the following:

Name, address and telephone number of the last high school you attended:

County

High school name

Number and street City Page 1 of 3

State

Zip Code

Telephone number October 2019

**Please enclose a copy of the school district waiver of compulsory attendance for the years you did not attend a Nevada public or private high school.

Actual Graduation Date____________________________________________

If you are part of the Class of 2016 or earlier, you must have passed all areas of the Nevada High School Proficiency Exam to qualify for the scholarship. When did you take the Nevada High School Proficiency Exam? Date Taken _________________________ Please attach a copy of the "Student Report" (results) of your Nevada High School Proficiency Exam.

To qualify for the Governor Guinn Millennium Scholarship, you must obtain a composite score of 21 or higher on the ACT Exam or an SAT score of:

Students who took the SAT test before March 2016: ? Must obtain a combined reading and math SAT score of 990 or higher Students who took the SAT test on or after March 2016: ? Must obtain a combined reading, writing and math SAT score of 1070 or higher)

Have you taken either the ACT or SAT Exam? Date taken

Please enclose an official sealed ACT/SAT score report or have the official score sent directly to our office.

SECTION III-Residency

Have you or your parent(s)/legal guardian(s) been a Nevada resident for at least two of your four high school years? Yes No

Since what date have you continuously lived in Nevada?

Mo. /Yr.

***Please review the "Declaration of Residency" form attached to this application and return the required documentation to verify the

2-year residency requirement

SECTION IV-Verification I hereby certify that the above information on this application form is true and accurate. I also understand that all required documents must be submitted before I (the student) can be determined to be eligible to receive GGMS scholarship benefits. I acknowledge that scholarship benefits may be terminated, and I will be required to repay scholarship funds for false information stated herein.

Signature of Student

Printed Name

Date

Signature of Parent or Legal Guardian

Printed Name

Date

SECTION V-Checklist of Requirements

I have enclosed or mailed an official, sealed high school transcript (required if you completed any courses in a high school) I have enclosed the attached Declaration of Residency Form and the required documentation I have enclosed a copy of the school district waiver of compulsory attendance I have enclosed a copy of the "Student Report" (results) of my Nevada High School Proficiency Exam (prior to 2017) I have enclosed or mailed an official, sealed ACT or SAT score report I have completed, signed, and dated my application

Mail the completed application and necessary documentation to: Governor Guinn Millennium Scholarship Program, 555 E. Washington Ave., Ste. 5200, Las Vegas, Nevada, 89101.

If you, your parent(s) or legal guardian(s) have any questions regarding the eligibility requirements. Please call the Governor Guinn Millennium Scholarship Program Office at (702) 486-3383 or toll free at (888) 477-2667.

*As required by Governor Guinn Millennium Scholarship Policy and Procedures of the Board of Regents Title 4, Chapter 18, Section 9.2; A student who is

not a high school graduate must apply for the Millennium Scholarship within the limitations established in Title 4, Chapter 18, Section 9.1.3 for the

student's normal year of high school graduation. Board of Regents, Nevada System of Higher Education website: system.nevada.edu.

Page 2 of 3

October 2019

DECLARATION OF RESIDENCY For Students Who Did Not Obtain a High School Diploma from a Public or Private High School

(Homeschooled Students)

I hereby declare that I have abandoned any domicile or residence in any state or commonwealth of the United States other than the State of Nevada, and I further certify that I or my parents have established a bona fide domicile or residence in the State of Nevada with the intent of making Nevada our true, fixed and permanent home and place of habitation, having clearly abandoned our former domicile or residence and having no intent to make any other location outside the State of Nevada my home and habitation.

I further certify that I or my parents have been domiciled or a resident in the State of Nevada for at least two years of the normal years of high school attendance. Signing a Declaration of Residency is not conclusive proof of residency and supporting documents will be submitted.

Student Signature Student Name: Mailing Address:

Parent Signature

Date

High School Graduation Year:

Telephone number

E-mail address

Filing a false Declaration of Residency may result in the re-payment to the Millennium Scholarship Trust Fund and/or loss of eligibility for the Millennium Scholarship. Please refer to the Board of Regents Handbook, Title 4, Chapter 18, Section 9 to read the residency guidelines.

Please provide supporting documentation to confirm residency. The two-year residency can be verified through: 1. Documentation of dependency if establishing residency through parent or legal guardian (i.e. federal income tax forms showing student as a dependent, child support stipulation, or divorce decree) 2. Documentation of residency of parent/legal guardian or student (i.e. NV or government issued identification) 3. Official High School Transcript from the previous Nevada high school the student attended

Please submit this form and supporting documentation to:

Gov. Guinn Millennium Scholarship Program, 555 E. Washington Ave., Ste. 5200, Las Vegas, NV 89101 Email: millenniumscholars@ Fax: (702) 486-3246

If you have any questions, please contact the Governor Guinn Millennium Scholarship Office at (702) 486-3383 or toll free at (888) 477-2667.

For Treasurer's Office Use Only: Residency Confirmed: _____ Yes _____ No Entered by:

If not, state reason: Date entered:

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October 2019

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