Returning Scholarship Recipient Appeal Form

First Name

M.I.

Last Name

Date of Birth

High School

Graduation Date

Street Address

City

State

Zip code

Phone

GPA last semester you attended Simmons or Jefferson (if applicable) .

Are you in good academic standing to return to Jefferson or Simmons?

Yes

Please describe for us why you believe, you should be eligible to continue the Evolve502 scholarship? Note: Be sure to provide details.

Is there anything else you would like us to know or anything you can provide to us to help make our decision about your eligibility for the Evolve502 Scholarship?

Attachments

Please include any attachments that may support your appeal (doctor’s note, transcript, etc.) This is not required.

Drop files here or

Accepted file types: pdf, doc, jpg, Max. file size: 50 MB.