Faculty Scholarship Chair Sign-off
Dental Hygiene Faculty Awards
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.
If you plan to have the award announced at Class Night and/or want the award listed in the Class Night Program Booklet, contact Jean Lovett, Office of Student Affairs at the Lincoln Campus (x7159).
Clinical Excellence
Selected recipient________________________________________ Student I.D. #___________________
Address___________________________________ City___________________ State______ Zip________
Telephone _____________________________________ email___________________________________
Dollar Amount of Award: $50
Clinical Grade Point Average: ________________ Note: Highest Clinical G.P.A. in class.
Name of Clinical Excellence Award Presenter for Class Night:_____________________________________
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Theoretical Excellence
Recipient Name__________________________________________ Student I.D. #___________________
Address______________________________________ City__________________ State______ Zip______
Telephone________________________________________ email_________________________________
Dollar Amount of Award $50
Overall Grade Point Average:________________ Note: Highest Overall G.P.A. in class.
Name of Theoretical Excellence Award Presenter for Class Night__________________________________
__________________________________________
Director of Dental Hygiene Signature / Date
