Application

This form will automatically be sent to John A. Logan College and you will receive a confirmation sent to the email you provide. Students must also complete a Free Application for Federal Student Aid (FAFSA) prior to the start of each semester. If you have questions about the form, please email promise@jalc.edu.

Student Information:

Full Student Name (First, Middle, Last): *

First

Middle

Last

Date of Birth: *

Mailing Address: *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Student Cell Phone: *

Parent/Guardian Phone: *

Student Email Address: *

Parent/Guardian Email Address: *

Expected High School Graduation Year: *

High School *

Agreement *

• I agree to the terms and conditions of the Promise Scholarship.

Submit