New Scholarship Form

Minimum for named scholarships: $1,500 per 5-Year Commitment

Scholarship Name

Scholarship Name to be printed on Program

Donor Name(s) to be printed on Program

Donor Name(s) as addressed in Thank You Letter

Number of Awards

Amount of Each Award

Scholarship Type

Will this be a Memorial Scholarship?

Yes

No

Will this be part of the Scholarship Awards Ceremony in June?

Yes

No

Primary Contact Name

First Name

Last Name

Phone

(###)

###

####

Email

Application Open Date

MM

DD

YYYY

Application Close Date

MM

DD

YYYY

Scholarship Eligibility Requirements will be listed on-line as follows:

Scholarship Description will be listed in the Scholarship Ceremony Program as follows::

Who Will Select the Scholarship Recipients?

Please select one option.

Mt. SAC Scholarship Committee

Independent Scholarship Committee

Special On-Campus Committee

I understand that this is the final documentation of this scholarship criteria and information. Any future changes I would like to make should be directed to the foundation

Thank you for your generous support! Please e-mail foundation@mtsac.edu with any questions or call the Foundation office at X4215