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Faculty Scholarship Chair Sign-off
Janet Lebkuchner 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.
Address____________________________________ City__________________ State____ Zip_____
Telephone__________________________________ e-mail__________________________________
1. Has the selected recipient completed their first year of studies at CCRI? Yes ___ No ___
2. Is the selected recipient continuing their studies at CCRI? Yes ___ No ___
3. What is the selected recipients G.P.A.? ____
4. Did the selected recipient submit a one-page essay about his/her interest in theatre or Costuming and how
he/she plans to use the scholarship? Yes ___ No ___
5. Does the selected recipient meet all the scholarship eligibility requirements? Yes ___ No ___
6. How many applications were received? ____________
7. Who was on the selection committee?
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Comments:
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Scholarship Chair Signature/Date
| OIA USE ONLY Payable to:
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