Faculty Scholarship Chair Sign-off
Lloyd S. Kaplan Music 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.
Name_________________________________________ Student I.D. #_________________________
Address______________________________________ City_________________ State ___ Zip______
Telephone ____________________________________ email_________________________________
1. Is the selected recipient enrolled in the A.F.A. Music program? Yes__ No__
2. Is the selected recipient entering A.F.A. Jazz Studies program? Yes__ No__
3. Is the selected recipient an instrumentalist continuing at CCRI? Yes__ No__
Which instrument?______________
5. Is the selected recipient a vocalist? Yes__ No__
Voice range? _______________
6. Has the selected recipient submitted a letter of recommendation from their music teacher? Yes__ No__
Academic teacher? Yes__ No__
High school transcript? Yes__ >No__
7. Did the selected recipient schedule an audition for CCRI music
Faculty prior to the beginning of the Fall
semester?
Yes__ No__
8. Does the selected recipient meet all scholarship eligibility requirements? Yes__ No__
Comments:
How many applications were received?
Who was on the selection committee? _____
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Scholarship Chair’s Signature/Date
| OIA USE ONLY Payable to:
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