Marlins Impact Stem Scholarship

Thank you for your interest! For additional information please complete this STEM Scholarship form
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Center for Enrollment 

5817 Wesleyan Drive 

Virginia  Beach, VA 23455

[email protected]

Thank you for your interest in the Marlins IMPACT STEM Scholarship Program at Virginia Wesleyan University!

Student Information

First Name *

Middle Name

Last Name *

Preferred First Name *

Date of Birth *

Email *

Street 1 *

Street 2

Street 3

City *

State/Province

ZIP/Postal Code *

Country/Region

Academic Information

Do you plan to live on Campus? *

Student Type *

Program of Interest *

Expected Entry Term *

Which Marlin's IMPACT Major are you interested in? *

School Information

Current School Name *

Education Level (Please select High School) *

Parent/Guardian Information

Parent/Guardian1 First Name

Parent/Guardian2 First Name

Parent/Guardian1 Last Name

Parent/Guardian2 Last Name

Parent/Guardian1 Email

Parent/Guardian2 Email

Parent/Guardian1 Mobile

Parent/Guardian2 Mobile

By signing below, I certify that the information provided is true and complete to the best of my knowledge. I understand that withholding or falsifying any requested information may result in the rejection of my application or expulsion from Virginia Wesleyan University. In completing this form, I accept and agree to abide by the policies and regulations of the University as specified in the Student Handbook, including those regarding drug and alcohol use, and understand that violations will subject me to the penalties specified in those policies and regulations.

I understand that by signing below Virginia Wesleyan University has permission to reach out to me via telephone, email, and text messaging in order to facilitate the completion of the application process.

I authorize the release of documents needed to progress my application, including official transcripts from institutions previously attended.

Signature

Thank you for your interest in the Marlins IMPACT STEM Scholarship Program at Virginia Wesleyan University!

Student Information

Contact Information

Academic Information

School Information

Parent/Guardian Information