Faculty Scholarship Chair  Sign-off

Liberty Mutual Business 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 continuing their education at CCRI?  Yes__ No__

2.  Is the selected recipient enrolled in the Business Administration Department at CCRI?  Yes__ No__

3.  Has the selected recipient listed community/school activities he/she has participated in?  Yes__ No__

4.  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 Signature / Date