Admission & Financial AidBreadcrumbHomeAdmission & Financial AidApply |Visit |Tuition & Fees |Financial AidThe John M. Belk Scholarship Nomination FormNotes for Counselors:Complete this form for your school's nominee(s) - one student nomination per form. Each school or community-based organization may nominate up to two students. Email confirmation of your nomination will be sent to you and your nominee. Deadlines:Nominations must be submitted by November 1 of the student's senior year.Your nominee(s) must submit an admission application by November 15. We will accept required supporting documents through November 30. *Required field Nominee Information Nominee First Name*Nominee Middle NameNominee Last Name*Nominee Birthdate*Nominee Birthdate*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900 email prioirity (hidden) email prioirity (hidden) High PriorityNormal PriorityLow PriorityInactiveemail device type (hidden)email device type (hidden)Email AddressPrimary PhoneMobile PhoneEvening PhoneAlternate PhoneSMS PhoneCampus EmailAlternate EmailProxy EmailNominee E-mail Address*Nominee High School Graduation Year*2025 Nominating Representative Information High School or CBO Program Name*CEEB*Nominating Representative - First Name*Nominating Representative - Last Name*Title*Phone Number*E-mail*By providing my initials here I certify the accuracy of the submitted materials, and that I am an official representative of the nominating school or CBO program.*Submit
