Student Application Form

Ahlijian-Pitts Scholarship

Instructions: Please print clearly or type. Return completed form to:
Ahlijian-Pitts Scholarship Committee
c/o  Associate Vice President for Student Affairs
Community College of Rhode Island
400 East Avenue
Warwick, RI 02886-1807

Applications must be hand delivered or postmarked no later than May 15.

Name____________________________________ Student I.D. #________________________

Address________________________________ City________________ State____ Zip______

Telephone______________________________ email_________________________________

1. Have completed at least 30 credit hours at CCRI towards completion of an Associates Degree program? Yes___ No___

2. What is your cumulative G.P.A.? _____

3. Are you continuing your education in your degree program at CCRI? Yes___ No___

4. Will you be carrying a minimum course load of 6 credits next semester? Yes___ No___

5. Have you applied for other CCRI scholarships, funds or awards? Yes___ No___

If yes, please list:

I grant my permission to the Scholarship Review Committee to review my academic standing with CCRI’s Office of Admissions and Records, to review my financial need with CCRI’s Financial Aid Office, and to use my name and photo for publicity purposes. I understand that all scholarship committee decisions are final.

_________________________________________________________________________
Student Signature/Date

Important Note: Scholarship recipient is required to write a thank you note (memo and sample thank you note) to the scholarship donor, and provide a brief biography (printable bio form) about themselves and their education/career goals and return both to: Geraldine Peixoto, CCRI Foundation, Flanagan Campus, 1762 Louisquisset Pike, Lincoln, RI 02865. Please contact the CCRI Foundation if you need assistance in completing this responsibility at 333-7150 or e-mail at foundation@ccri.edu.