ANCHOR SCHOLARSHIP FOUNDATION ELIGIBILITY APPLICATION

Deadline Date: Must be received by March 1

SCHOLARSHIP APPLICANT NAME (PLEASE PRINT):

Privacy Act Statement

Authority to request this information is derived from 5 United States Code 301 Department Regulations. The purpose of the information is to apply for educational financial assistance through the Anchor Scholarship Foundation. Information provided will be used to assess scholastic achievement and to evaluate need for financial assistance. Completion of this form is mandatory; failure to provide required information may result in disqualification from participation in the Anchor Scholarship Foundation Program. Agreement of Scholarship Applicant: 1. The Anchor Scholarship Foundation shall have discretionary authority in all matters pertaining to the scholarship. 2. I certify that all information in this application is complete and accurate to the best of my knowledge, and I will notify the Anchor Scholarship Foundation if there are any changes. The scholarship may be revoked if I fail to do so. 3. The completed pre-qualification form must be received no later than the stated deadline. The form should be sent to the scholarship chairperson. Signature of Applicant ___________________________________________________ Date: __________________

REQUIRED INFORMATION CHECKLIST:

Completed eligibility application Attached Proof of applicants relationship to sponsor-ONE-of the following: if active duty, copy of Page 2 or applicants military ID card (front and back) a copy of applicants birth certificate front page of 1040 tax form listing applicant as dependent Attached proof of SPONSOR ELIGIBILITY: Officers, Enlisted AND Retired must submit proof of SWO/ESWS qualification- copy/ies of SWO or ESWS certificate or NAVPERS 1070 (p.13) Administrative Remarks Officers copy of sponsors Officer Data Card or detaching FITREP from each qualifying command Enlisted copy of the Administrative Data and Career History pages of sponsors Electronic Training Jacket Retired copies of sponsors service record NAVPERS 1070 History of Assignments (Page 5) and DD 214
In some cases, additional documentation may be required.

Useful Links for obtaining service record information: BUPERS ONLINE (BOL) NAVY KNOWLEDGE ONLINE (NKO) COMMANDER, NAVAL MILITARY PERSONNEL COMMAND NATIONAL PERSONNEL RECORDS CENTER (NPRC). The Scholarship Foundation will only consider your eligibility application if all required paperwork submitted together in a complete packet is RECEIVED BY MARCH 1. No faxed or email copies will be accepted. If you have not received an email regarding your eligibility status within 10 business days after mailing your eligibility application, please contact us at scholarshipadmin@anchorscholarship.com to ensure it was received. Please be advised that early submission is best. Once eligibility is confirmed, the scholarship application will be sent via email. The APPLICATION and all supporting documents must be postmarked April 1. Please mail them to:

ANCHOR SCHOLARSHIP FOUNDATION Scholarship Chairperson

4966 Euclid Road Suite 109 Virginia Beach VA 23462 Questions? Please email: scholarshipadmin@anchorscholarship.com
Anchor Scholarship Foundation is a Virginia Corporation, which meets tax-exempt status under IRS code 501 (c) (3)

Anchor Scholarship Foundation

Eligibility Application

PLEASE WRITE LEGIBLY

CHECK THE ONE THAT MOST ACCURATELY APPLIES:

HIGH SCHOOL SENIOR COLLEGE STUDENT (FULL TIME, PURSUING A BACHELORS DEGREE)
FRESHMAN MILITARY SPOUSE PART I: APPLICANT INFORMATION
FULL NAME: DATE OF BIRTH:

SOPHOMORE

JUNIOR

PERMANENT MAILING ADDRESS:

PHONE NUMBERS:

H)
EMAIL ADDRESS (S): (PLEASE LIST AT LEAST TWO)

W) C)

PART II: MILITARY SPONSOR INFORMATION

FULL NAME: HOW DID YOU HEAR ABOUT ASF? LAST RANK/ GRADE HELD:

MAILING ADDRESS (IF DIFFERENT FROM ABOVE):

PHONE NUMBERS:

ENLISTED RATING OR OFFICER DESIGNATOR:

H)
SELECT ONE: RELATIONSHIP OF SPONSOR TO APPLICANT:

W) ___ Active Duty C)

EMAIL ADDRESSES: HOME AND/OR WORK

___ Retired
NAME OF OTHER PARENT OR GUARDIAN:

___ Deceased
(please submit death certificate)

PREVIOUS APPLICANTS: If you have pre-qualified, please indicate the year in which your eligibility was confirmed. If you are the sibling of a prequalified applicant, please indicate the year in which his/her eligibility was confirmed AND their name.

_______________________YEAR and/or

SIBLING OF _______________________________________________

PART III: Qualifying commands under the Administrative control of US Naval Forces, Atlantic Fleet and/or US Naval Forces Pacific Fleet Beginning with most recent (or current) command, please list the dates served and duty assignments in commands under the administrative control of US Naval Surface Forces, Atlantic Fleet and/or US Naval Surface Forces, Pacific Fleet (minimum requirement: 6 years, cumulative; need not be consecutive). While all assignments are listed on your service record, this will help the Anchor Scholarship Foundation identify those commands you believe contribute to the 6-year requirement. THIS FORM MUST BE FILLED OUT. We will not accept see attached or blank forms. *Any child (natural born, adopted or step-child) of a member of the U.S. Navy who has died while on active duty serving with Surface Navy forces as described above, may qualify, regardless of the length of service of the deceased parent.

MM/YY to MM/YY

Total Time in Months

Command Name

Command Location

Total Time
(minimum: 72 months)

Date of Surface Warfare (Officer/Enlisted) Qualifications:

END OF PRE-QUALIFICATION FORM #####