Loudoun Valley High School
Scholarship Application Checklist
(non-Loudoun County only)
Student Name: ________________________________________________________
Student ID: _______________
Students: Please use one form for each non-county scholarship application.
Loudoun Valley High School requires a minimum of 3 weeks to process requests.
Scholarship Name: _____________________________________
*Please be specific- DO NOT use abbreviations
Deadline: _______________
Date Application submitted:_____________
WILL STUDENT PICK UP TRANSCRIPT?
 YES
 NO
If no, please list address of where scholarship should be mailed:
Please check all that apply:
 Need Transcript
 Need Counselor Letter of Recommendation
Please sign below that you have read and understand the scholarship application
requirements and the information above is accurate. Your signatures below
authorize Loudoun Valley High School to complete your request and to have the
above information released.
Student Signature:
Parent Signature:
Date: ______________
Date: ______________
GUIDANCE USE ONLY
Date
Date Received
Transcript Processed
Counselor Recommendation
Logged in Naviance
Mailed
Verified
Initials