Faculty Scholarship Chair Sign-off
Dr. Joseph A. Yacovone Scholarship for Dental Assisting Students
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 been accepted into CCRI’s Dental Assisting Program? Yes__ No__
2. Has the selected recipient enrolled in the Dental Assisting Program in the upcoming fall semester? Yes__ No__
3. Has the selected recipient adequately described his/her need for financial assistance? Yes__ No__
4. Has the selected recipient adequately described his/her interest in Dental Assisting? Yes__ No__
5. Has the selected recipient fully completed the application form? Yes__ No__
6. Did the selected recipient submit his/her application on or before August 14 fall/January 1 spring? Yes__ No__
Comments:
How many applications were received? ______
Who was on the selection committee?
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Scholarship Chair Signature/Date
