Scholarship Plug Community Impact Interest Form

Scholarship Plug Community Impact Interest Form

Thank you for your interest in becoming a Community Impact Partner.We are building a network of committed partners dedicated to advancing student success, expanding scholarship access, and creating lasting community impact.Please complete the form below to get started.
Section 1: Contact Information
Name:

First NameLast Name
Email:
Contact Number:
Address

CityState / Province

Postal / Zip CodeCountry
Section 2: Partner Type
Organization Name:
Which best describes you?

Other
Section 3: Impact Levels

🏆 Platinum Community Member

$1200 or $100/month Supports 12 Students

🥇 Gold Community Member

$750 Supports 6 Students

🥈 Silver Community Member

$300 Supports 2 Students

🥉 Bronze Community Member

$175 Supports 1 Student
Please Select Your Impact Level

Other
My Products
prevnext( X )
Platinum Impact $1,200.00
Platinum Community Member

Quantity

Gold Impact$750.00
Gold Community Member

Silver Impact$300.00
Silver Community Member

Bronze Impact$175.00
Bronze Community Member

Platinum Impact - Monthly$100.00
This payment option is being billed on a monthly basis for 12 months.

Quantity

Total $0.00
Should be Empty:

Section 1: Contact Information