State Bank Scholarship Acceptance Form

STATE BANK SCHOLARSHIP ACCEPTANCE FORM

If you have received a scholarship notification letter from State Bank of Southern Utah, please fill out the necessary information below to accept your scholarship.
Name:*
Phone*
Email:*
example@example.com
High School:*
Other High School:*
College or University that you are enrolled in (and their mailing address):*
This is where we will send your scholarship.
College Student ID #*
When do you start?*
Scholarship Deferral:
If you choose to defer your scholarship, you must still complete this form. When you are ready to resume school, contact the local branch that awarded you the scholarship, and they will send the funds to your chosen school.
First Date of Classes:*

MonthDayYear
Scholarship funds will be submitting around one month prior to first day of classes.
Annual Household Income*
Why do we collect this information? Banks are required to collect household income data to comply with the Community Reinvestment Act (CRA). This information helps us assess our performance in meeting the credit needs of our community and ensures that we are serving all areas fairly and without discrimination. This information is not used to determine whether a person receives a scholarship or not.
Annual Household Income (Washington County)*
Why do we collect this information? Banks are required to collect household income data to comply with the Community Reinvestment Act (CRA). This information helps us assess our performance in meeting the credit needs of our community and ensures that we are serving all areas fairly and without discrimination. This information is not used to determine whether a person receives a scholarship or not.
I certify that the information provided above is accurate. I understand that the scholarship funds will be sent directly to my chosen institution and must be used for tuition, books, housing, or meal plans.

If I choose not to attend or do not use the funds for their intended purpose, I agree to request the scholarship funds to be reimbursed to State Bank of Southern Utah.
Signature*

Clear
Please verify that you are human*
Should be Empty:

STATE BANK SCHOLARSHIP ACCEPTANCE FORM