□ 
□ 
 
 
 
 
 
 
 
Full Name:  
SS# 
 
 
Male     
 
 
Female    
 
 
Address:  
Duration at Address   
 
 
Forwarding Address:   
 
[Please include address where you will reside while in school] 
Place of Birth:  
Date of Birth:  
Driver’s License No. and Jurisdiction  
 
Email Address:  
Alternate Email Address:  
Telephone: 
 
 
Name and Address of Institution:                                                                                                                                      
 
 
 
Degree Objective & Field of Study:  
Anticipated graduation date:   
 
Program Advisor/Contact No.   
 
 
 
U.S. Citizen 
YES 
NO 
If not a U.S. Citizen, fill in the 
information below: 
 
CITIZEN OF:   
 
RESIDENT OF:   
 
INS No:    
 
LENGTH OF VI RESIDENCY:   
 
 
BY EXECUTION OF THIS APPLICATION FOR FUNDING BELOW, THE APPLICANT ACKNOWLEDGES THAT HE/SHE HAS RE- 
CEIVED A COPY OF THE VIRGIN ISLANDS ACADEMIC AND CULTURAL AWARDS ENDOWMENT RULES AND REGULA- 
TIONS AND THAT THIS APPLICATION IS SUBJECT TO THESE RULES AND REGULATIONS, WHICH MAY BE AMENDED 
FROM TIME TO TIME. AWARDS ARE CONTINGENT ON THE AVAILABILITY OF FUNDS FOR FISCAL YEAR 2026-2027 
 
 
 
Recipient’s Signature 
Date
 
 
 
The application must be accompanied by: 
 
1. 
Completed Certification Form 
2. 
Proof of acceptance and enrollment into an 
approved program at an accredited 
graduate or professional school 
3. 
Two (2) letters of recommendation from 
people not related by blood or marriage 
4. 
Federal Student Aid Report from the 2025-
2026 FAFSA 
5. 
Copy of 2026 Income Tax Return 
6. 
Complete explanation of other sources of 
funds 
7. 
Resume’ reflecting eligibility for this award 
 
8. 
Proof of Virgin Islands residency for 
at least ten years, five {5} of which 
much immediately precede the date 
of submission of the application 
 
SUBSCRIBED AND SWORN TO BEFORE ME THIS  
DAY OF  
, 20  
 
by  
. 
Known to me or satisfactorily proven by presentation of identification in the form of  
. 
NOTARY PUBLIC 
RESIDENCY REQUIREMENT: Applicants must have resided in the U. S. Virgin Islands for at least 10 years, 5 of which must immediately precede date of application. 
ESTIMATED ANNUAL EXPENSES: 
VIRGIN ISLANDS ACADEMIC & CULTURAL AWARDS ENDOWMENT APPLICATION 
 ACADEMIC PROGRAM 
2026-2027 
Tuition & Fees $  
 
Room & Board $ 
 
Books 
$   
 
Other 
$   
 
TOTAL: 
$   
 
Amount Requested: $   
 
Academic Period(s) covered 
by  funding request:   
 
Other Sources of Funding: 
1) Personal   $  
 
2) Family 
$  
 
3) Other 
$  
 
TOTAL: 
$