Reidsville Vicinity Eligibility Appeal Form

							                    SANDS SCHOLARSHIP APPLICATION
                    Reidsville Vicinity Eligibility Appeal Form
The Claire Huneycutt Sands Scholarships are funded by the will of Royal W. Sands who
directed that scholarships were to be provided to “children of Methodist families in the
Reidsville vicinity.” The Sands Committee has defined the “Reidsville vicinity” as an
area around Reidsville as outlined by a map approved in 1996 and revised in 2009.

Students who live outside the eligibility vicinity map approved in 2009, but who believe
they should be included in the “Reidsville vicinity” may appeal their status by completing
this form in addition to the Sands Scholarship Application Form and submitting it to:
Sands Scholarship Committee, Main Street United Methodist Church, P O Box 338,
Reidsville, North Carolina 27323-0338.

   1. Name of student and permanent home address:


   2. Name and address of high school from which student graduated

        __________________________________________________________________

   3. Name and address of student’s employer (If applicable):

       __________________________________________________________________

   4. Name and address of father’s employer



   5. Name and address of mother’s employer



   6. Name and address of primary family physician



   7. Name and address of primary family dentist



   8. Name and address of supermarket where your family most often buys its groceries

        __________________________________________________________________
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                 Reidsville Vicinity Eligibility Appeal Form (Page 2)
9. Does the student or either parent have a Rockingham County Library card issued
   by the Reidsville Public Library? If so, who has the card and when was it issued?

     __________________________________________________________________

10. Name and address of barber and beauty salon where parents normally get their
    hair cut or styled.

     Father ____________________________________________________________

     Mother ___________________________________________________________

11. Is the student or parent(s) a member of the Reidsville Family YMCA? If so, who
     are members and when did they join?

     __________________________________________________________________
     __________________________________________________________________

12. Has the student or parent(s) participated in activities sponsored by the City of
    Reidsville Recreation Department? If so, please elaborate.

     __________________________________________________________________
     __________________________________________________________________
     __________________________________________________________________
     __________________________________________________________________
     __________________________________________________________________
     __________________________________________________________________

13. Please list any Reidsville civic or social organizations to which any member of
    the family belongs and the date joined.

     __________________________________________________________________
     __________________________________________________________________
     __________________________________________________________________




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                    Reidsville Vicinity Eligibility Appeal Form (Page 3)

   14. Are there other factors you believe the Committee should consider in deciding
       whether you should be included in the “Reidsville vicinity” eligibility area?
       Please elaborate. (Please attach additional pages as needed).

         _______________________________________________________________
         _______________________________________________________________
        ________________________________________________________________
        ________________________________________________________________
        ________________________________________________________________



The answers to these questions are true and complete to the best of our knowledge and
belief:

Student’s signature _____________________________ Date __________________
Father’s signature ______________________________ Date __________________
Mother’s signature ______________________________ Date __________________




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