Release Statement for Release of Financial Need Results
I request that the Financial Aid Office of Appalachian State University provide results of my financial need analysis to the S-STEM scholarship committee for the purpose of consideration for this scholarship.

First Name: _______________ Last Name: ____________________ MI: ___

Banner ID (current or admitted students): ________________________

OR SSN: ________________________________

Email Address: __________________________________

Major(Intended Major for incoming freshmen): ________________________

Phone: ( ____ ) ____ - ______

Signature: ____________________________________ Date: _______________

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Mail this form or submit it to:
S-STEM Scholarship Program
c/o Dr. Rahman Tashakkori
Department of Computer Science
CAP Building
Appalachian State University
Boone, NC 28608

Supported by the National Science Foundation grants S-STEM-0630984 and S-STEM-0756928