BAY MILLS COMMUNITY COLLEGE
BOARD OF REGENTS SCHOLARSHIP APPLICATION

Completion of this form is required to apply for the Bay Mills Community College Board of Regents Scholarships. You will be required to provide a copy of your Tribal Membership Card.
STUDENT PORTION
NAME:    Last    First    Middle    Maiden		BIRTHDAY (mm/dd/yy)	SOCIAL SECURITY NO.
ADDRESS:      Street      City      State      Zip code			TELEPHONE NO. & AREA CODE
MI DRIVER LICENSE NUMBER		NAME OF MICHIGAN FEDERALLY RECOGNIZED TRIBE
GENDER Please select MALE FEMALE	MARITAL STATUS Please select SINGLE MARRIED DIVORCED HEAD OF HOUSEHOLD	No. of Children in Household Please select One Two Three Four Five Six More than 6
GENEALOGY INFORMATION
PATERNAL: TRIBE (BAND):		MATERNAL: TRIBE (BAND):
Father's Name:		Mother's Name:
Grandfather's Name:		Grandfather's Name:
Grandmother's Name (Maiden):		Grandmother's Name (Maiden):
Applicant's Signature:		Date:

You will be notified of approval or disapproval of your application.
If you have any questions please contact Financial Aid Department.