Name of Program(s) Dates Involved Applicant’s First & Last Name: What is your annual household income? A B STUDENT’S INCOME FAMILY’S INCOME $ $ Savings + + $ $ Work + + Social Security / COLUMN A TOTAL $ $ TANF / + Veterans Benefits COLUMN B TOTAL = = + = $ $ $ TOTAL How many dependents live in your household (including yourself)? Have other members of your family attended college? Yes No If yes, please list their names below: IMPORTANT NOTICE The Urban League of Nebraska will award two different types of scholarships:
Name of Program(s) Dates Involved Applicant’s First & Last Name: What is your annual household income? A B STUDENT’S INCOME FAMILY’S INCOME Savings $ $ + + Work $ $ + + Social Security / TANF / Veterans Benefits $ $ COLUMN A TOTAL + COLUMN B TOTAL = = TOTAL $ + $ = $ How many dependents live in your household (including yourself)? Have other members of your family attended college? Yes No If yes, please list their names below: IMPORTANT NOTICE The Urban League of Nebraska will award two different types of scholarships:
2016-2017-ULN-MCC-Scholarship-Application.docx