Levine Scholars Program Self-Nomination Form

Self-Nomination Form

Thank you for your interest in the Levine Scholars Program!

To access the application, students must be nominated by a high school counselor/college advisor or complete this self-nomination form. If you have already been nominated by your school counselor or advisor, please do not submit this form.

The self-nomination option exists to ensure access for high-achieving high school seniors whose schools do not typically participate in the counselor/advisor nomination process. Before self-nominating, we strongly encourage you to speak with your school counselor or college advisor to learn more about the program and ask whether a school nomination is possible.

If a school nomination is not available to you and you believe that you are highly qualified after reviewing the selection criteria, we encourage you to fill out the self-nomination form. The nomination period is from Aug. 15 to Oct. 15.

Minimum Eligibility Requirements:

Students must be applicants for first-year enrollment at UNC Charlotte in an undergraduate program for the fall term immediately following their high school graduation (no gap year)
Students must be current high school seniors
Students must be U.S. citizens or permanent residents

Personal Information

Form Submission Date

First Name

Preferred First Name

Middle Name (if applicable)

Last Name

Suffix

Birthdate

Email Address (please use a personal email as school emails have restrictions that may prevent you from receiving our messages)

Preferred Pronouns

What are you interested in studying?

Intended Start Term (applicants must enroll full-time as a degree-seeking student for the fall semester immediately after high school graduation):

Contact Information

Mobile Phone

Mailing Address

Country

Street

City

Region

Postal Code

High School Information

Where are you attending high school?

CEEB

When will you graduate?

Self-Nomination Questionnaire

The questions listed below are designed to help evaluate your level of competitiveness for the Levine Scholars Program. Before completing the questionnaire, we encourage you to learn more about the Levine Scholarship.

1. Are you a current high school senior enrolling for the fall term immediately following your high school graduation?

Yes

No

2. Are you a U.S. citizen or permanent resident?

Yes

No

3. Have you demonstrated an extraordinary commitment to community service through volunteerism or by participating in, and organizing programming or events designed for the benefit of others?

Yes

No

4. Have you taken the most rigorous curriculum available at your high school and excel academically?

Yes

No

5. Have you held formal or informal leadership roles in your high school, community or social organization?

Yes

No

6. Do you have a minimum unweighted GPA of 3.75 and/or a minimum weighted GPA of 4.0?

Yes

No

Parent/Guardian Information

Would you like to provide Parent/Guardian Information?

Yes

No

Parent/Guardian type:

First Name

Last Name

Email (the program may email parents important information and reminders)

Would you like to provide a second parent's/guardian's contact information?

Yes

No

Parent/Guardian type:

First Name

Last Name

Email (the program may email parents important information and reminders)

Levine Scholars Program Self-Nomination Form

Academic Excellence

Additional Resources