Faculty Scholarship Chair Sign-off
Christina M. Liston Scholarship
Instructions: Complete this form, sign and date it, and return the form along with ALL the scholarship applications to: Geraldine Peixoto, CCRI Foundation, Flanagan Campus. Upon receipt of all the applications and the sign-off form, the Office of Institutional Advancement will process the scholarship award within two weeks and mail the check to the selected recipient.
If you plan to have the award announced at Class Night and/or want the award listed in the Class Night Program Booklet, contact Jean Lovett, Office of Student Affairs at the Lincoln Campus (x7159).
Name____________________________________________ Student I.D. #_______________________
Address ___________________________________ City__________________ State____ Zip_________
Telephone:___________________________________ e-mail___________________________________
1. Is the selected recipient a graduating student? Yes__ No__
2. Has the selected recipient achieved a minimum grade point average of 3.5? Yes__ No__
3. Has the selected recipient attended the Liston Campus? Yes__ No__
4. Has the selected recipient been accepted at a four-year institution for continued studies toward a bachelor’s degree in business, computer science, or a related field? Yes__ No__
5. Has the selected recipient demonstrated personal initiative at CCRI? Yes__ No__
6. Has the selected recipient participated in, and demonstrated
leadership in, extracurricular activities?
Yes__ No__
7. Does the selected recipient meets all the scholarship eligibility requirements? Yes__ No__
Comments
How many applications were received? ___________
Who was on the selection committee?
____________________________________
____________________________________
____________________________________
Who will be presenting the award at Class Night? ______________________________
_________________________________________________
Liston Campus Scholarship Chair signature / Date
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