MASF Scholarship Request Submission Form

National Scholarship Award Request Form

Applicable for Miss America 2022 & 2023 scholarship awards. Also applicable for 2024 Miss America's Teen and Miss America national scholarship awards.
Name of Delegate

First NameLast Name
Miss or Miss Teen Title Held at the Time of the Award
Cellular Phone Number of Delegate
Please enter a valid phone number.
Email of Delegate
example@example.com
I certify that as of the date of this request, I am currently enrolled as a full-time student, in an accredited undergraduate program, or a graduate program, leading to an academic degree, and that I am submitting this form to request scholarship funds. I further agree I will abide by all the IRS rules for scholarship payments to tuition-only degreed programs, and acknowledge that any attempt to receive funds fraudulently, or apply funds in a taxable manner, may result in my forfeiture of any remaining scholarship and possible criminal charges.

Miss America’s Scholarship Foundation, Inc. (MASF) awards tuition-only scholarships paid directly to accredited educational institutions on behalf of the recipient and cannot be transferred or utilized for non-educational purposes. Recipients must fulfill all requirements set forth by MASF and the IRS to remain eligible for scholarship disbursement.
Signature

Clear
Enter name of Academic Institution
Enter Degree Program Enrolled
Enter Student ID
Enter Address of Academic Institution

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Enter Email for College Cashier's Office/Student Financial Affairs
example@example.com
Scholarship Award was awarded at:

2022 Miss America2023 Miss America2024 Miss America2022 Miss America's Teen2023 Miss America's Teen2024 Miss America's Teen
Type of Scholarship Award:

Non Finalist AwardFinalist Award - Write in Placement Award Name BelowPreliminary Award - Write in Name of Award BelowOther Award - Write in Name of Award Below
Please list all names of the Award and/or Awards Requested.
Name/Address of School/University and Remittance Information
Name of Parent/Guardian (if delegate is a minor)

First NameLast Name
Email of Parent/Gaurdian (if delegate is a minor)
example@example.com
Cellular Phone Number of Parent/Gaurdian (if delegate is a minor)
Please enter a valid phone number.
Name of State Director

First NameLast Name
Email of State Director
example@example.com
Cellular Phone Number of State Director
Please enter a valid phone number.
File Upload: Delegate Letter Requesting Specific Award - You must name the type of award, the year and the total amount of award you are requesting. Awards are given for TUITION ONLY and you must be currently enrolled in school with full-time credit load. If you are requesting only a portion of funds, or have requested funds previously please include this information in your letter, along with complete contact information.

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File Upload: State Director Letter Confirming State Awards are Exhausted. Must include the amount of State Awards that were both awarded, and claimed, and date claimed. Must also be SIGNED by the Executive State Director.

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File Upload: Course Statement/Schedule (outlining classes for upcoming Semester)

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File Upload: College/University Statement or Invoice (must include amount owed and have a visible reference to the Semester and courses also submitted).

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Date of Graduation from High School (applicable to Teen delegates only).

MonthDayYear
Date
Other File Upload(s):

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Additional notes:
Should be Empty:

National Scholarship Award Request Form