Eligible students must reside in a qualifying Golden LEAF County. You must have JavaScript enabled to use this form. Current Personal Information Educational Information Other Information Applicant Certification Complete Required fields are marked with an asterisk '*'. Student Full Name * First * Middle * Last * Student Email * Student ID * Phone * Address * Address * City/Town * State/Province * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code * NC County of residence * More Info (To be eligible for an initial scholarship award, your permanent residence must be a qualifying Golden LEAF County) Length of residence in county * - Select -1 year or lessat least 5 yearsmore than 5 years