Application Form
Print form and mail to USS Newport News Liaison Committee; ATTN: Scholarship Chairman; P.O. Box 120424; Newport News, VA 23612-0424

Name:__________________________________________________________________

Address:________________________________________________________________

City: _______________________________________State:_______ Zip Code:________

Telephone:________________ Rank, if applicable: ______________________________

Email Address: _______________________________________

Social Security Number: _______________________ Birthdate: ___________________

College/University/Tech Institute to be attended: ________________________________

Date of entry to above institution: __________ Est. date of completion: ______________

Name and Rank/Rate of eligible crewmember: ____________________________________________________________________________________

Relationship to crewmember, if applicable: _______________________________________________________________________

Period of service on USS Newport News:______________________________________

Applicant Signature: _______________________________ Date Submitted: _________

Applicant:
Please submit the following with your application:

Full address of the institution you are, or will be, attending (make sure you include the department/office the scholarship check is to be sent).
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