For NSHE System Administration Use Only:
Approved: _____ Yes _____ No
Date sent to Treasurer’s Office:
Date scholarship extended to:
For Treasurer’s Office Use Only:
Date scholarship extended to:
June 2016
APPLICATION FOR EXTENSION OF SCHOLARSHIP EXPIRATION DATE
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
organization.
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
assignment.
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.
