Blue Cross and Blue Shield of North Carolina 2022-23
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 Lexie Daniels at [email protected] or 919.832.5817.

Blue Cross and Blue Shield of North Carolina 2022-23
GPA: (select one)
2022-23 CLASS: (select one) *
ARE YOU A FIRST GENERATION COLLEGE STUDENT?
GENDER:
ETHNICITY: (select one)
STUDENT PERMANENT ADDRESS *
STUDENT PERMANENT ADDRESS
City
State/Province
Zip/Postal
Country
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

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