Vivian Deloris Norman Scholarship Foundation

 

 

The Vivian Deloris “Lois” Norman Scholarship Fund

 

 

Please PRINT or TYPE.

Name _______________________________________________________________________________________________________________  

Home Address _________________________________________________________________________________________ Apt. # __________

City _________________________________________________________ State __________ Zip Code ________________Country __________

Professional Title _______________________________________________________________________________________________________

Business Name ________________________________________________________________________________________________________

Business Address ______________________________________________________________________________________________________

City _______________________________________________________ State __________ Zip Code _________________ Country __________

Home Phone (______) _______________________________________ Business Phone (_____) _______________________________________

Email ________________________________________________________

 

PAYMENT METHOD Form of payment (check one):

 

Support will be provided through:

 

___Cash Contribution Total support $_____________

 

___Check or Money Orders  (make payable to ViDN Scholarship) Total support $____________

 

Send completed form to:

 

                                                                       Vivian Deloris Norman Scholarship Fund

                                                                                     Post Office Box 152

                                                                                Roper, North Carolina 27970

 

For More Information, contact (252) 724-0593 or email gloriaoutlaw@aol.com