BRMA Scholarship Student Agreement Form

Chapel Hill-Carrboro Public School Foundation Scholarship Student Agreement

Student Name *

Student Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Student Phone *

Student Email (AFTER HIGH SCHOOL) *

example@example.edu

College/University Attending *

College Office Address to send funds *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Student ID# at College *

Scholarship Name: *

Haidt SAS Caroline Lindsay Rise NOW Nathaniel & Peggy Davis Scholarship Other

*Scholarship checks will be mailed to the college or university on or around July 30.

The Chapel Hill-Carrboro Public School Foundation is pleased to designate the above-named student a scholarship/award recipient in recognition of prior academic excellence, demonstrated leadership qualities, and outstanding intellectual promise. Each recipient agrees to the following terms:

1.) Scholarship recipient will attend (name of college) *

2.) The recipient elects to allocate their funds to: (specify tuition, room, board, books, technology *

3.) The Scholarship will be canceled if the recipient does not enroll in, or discontinues his or her studies at an accredited four-year, post-secondary academic university, college or similar school institution, or upon failure to maintain the strong academic requirements needed for college enrollment.

4.) The Scholarship will be canceled if the recipient is censured by the post-secondary institution or convicted of a crime.

I accept the above and agree to the stated terms and conditions.

Signature *

Clear

Date *

Date

Return form to PSF at psf@chccs.k12.nc.us or PO Box 877, Carrboro 27510