Faculty Scholarship Chair Sign-off
Walter & Eileen J. Jachna 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 currently an enrolled student who is majoring in:
Paralegal Studies Program ___
Nursing Program___
Developmental Disabilities Certificate Program___
2. Is the selected recipient currently registered for at least 9 credit hours at CCRI? Yes__ No__
3. Has the selected recipient completed at least twelve credit and two semesters toward his/her degree
Yes__ No__
4. Has the selected recipient maintained at least a 3.0 G.P.A. in his/her major? Yes__ No__
5. Is the selected recipient a U.S. citizen (or naturalized)? Yes__ No__
6. Has the selected recipient included:
documentation regarding school and/or community activities___
description of financial aid needs___
300-400 word essay describing career goals and commitment to career___
7. The selected recipient meets all the 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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