Scholarship Chair Sign-off

Ahlijian-Pitts 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. Has the selected recipient completed at least 30 credit hours at CCRI towards completion of an Associates Degree program? Yes__ No__
  2. What is the selected recipients cumulative G.P.A.? (Must be 3.2 or higher) _________
  3. Is the selected recipient continuing his/her education in their designated degree program at CCRI? Yes___ No___
  4. Is the selected recipient carrying a minimum course load of 6 credits next semester? Yes___ No___

Does the selected recipient meets all the scholarship eligibility requirements? Yes__ No__

Comments: _______________________________________________________________________________

________________________________________________________________________________________

How many applications were received? _____

Who was on the selection committee?

___________________________ _________________________________ ______________________________


____________________________________________________________________________________
Scholarship Chair’s Signature/Date

OIA USE ONLY

Payable to:

  • Student only
  • Student & CCRI
  • Student & 4-year Institution
  • Acceptance Letter
  • Award Amount: $ _____________________
  • Thank You Letter
  • Bio Form
  • Account name: