For NSHE System Administration Use Only:
Approved: _____ Yes _____ No
If not, state reason:
Entered by:
Date student notified:
Date sent to Treasurer’s Office:
Date scholarship extended to:
For Treasurer’s Office Use Only:
Date scholarship extended to:
June 2016
Student Name: MSID#:
Mailing Address:
Email: Telephone:
High School: Graduation Date:
Pursuant to the Nevada System of Higher Education Board of Regents Handbook, Title 4, Chapter 18, Section 9.7.4, I
hereby request a one-time extension to the expiration deadline of my Governor Guinn Millennium Scholarship.
Please check one:
I certify that I have been actively serving in the military in a branch of the United States Armed Forces
I have attached supporting documentation of my military service (i.e. DD-214 (Discharge Orders)).
I certify that I have been actively serving or participating in a charitable, religious, or public service assignment or mission
I have attached an official letter from the organization which I volunteered or other documentation stating the starting
and ending dates of my service assignment or mission, which has been signed by an authorized representative of that
I understand this application is available for students who qualified for the Governor Guinn Millennium Scholarship when
they graduated from high school.
I consent that the military, service, or religious organization may be contacted to verify my length of service or
Student Signature Date
Please mail this application and appropriate supporting documentation to:
Director of Financial Aid, NSHE Administration Office, 2601 Enterprise Road, Reno, Nevada 89512
*Within 30 days of receipt of this form, you will be contacted regarding the status of your application.
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