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?

_______________________________

_______________________________

_______________________________

 

_______________________________________________
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