Blue Cross and Blue Shield of North Carolina 2021-22
Student Selection Form
Form should be filled out by the Financial Aid office

Requirements:
– Resides in North Carolina,
– Demonstrates financial need according to federal guidelines, and
– First Generation, Low Income, or Minority Student
– Minimum GPA of 2.5
– Junior or Senior Status

If you have any questions about this form, please contact Colleen Kinser at [email protected] or 919.832.5817.

Blue Cross and Blue Shield of North Carolina 2021-22
GPA: (select one)
2021-22 CLASS: (select one) *
ARE YOU A FIRST GENERATION COLLEGE STUDENT?
GENDER:
ETHNICITY: (select one)
STUDENT PERMANENT ADDRESS *
The student understands that if s/he is selected for this scholarship, his/her name, information, and/or picture may be used in future promotional materials in relation to this program.

Blue Cross and Blue Shield of North Carolina