Scholarship Request for Tuition
If you are submitting a scholarship payment request for a student loan, please use the Student Loan scholarship request form.
Before beginning with this form, please download and read our State Scholarship Rules & Regulations.
Before completing this form, please download and read our State Scholarship Application Procedures.
I have read the Scholarship Rules and Scholarship Application Procedures.
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Agree
BASIC APPLICANT INFORMATION
Scholarship Applicant Name
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First Name
Last Name
Contestant/Titleholder Mailing Address (This is where we will mail your scholarship check).
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Date of Birth
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
LIST ALL AWARDS FOR WHICH YOU ARE APPLYING
Date of competition for which scholarships were awarded.
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
List all scholarships/amounts you were awarded. For example, Miss Arizona Volunteer $3500; Community Service Award $100.
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COLLEGE/UNIVERSITY INFORMATION
Name of College/University to which the check should be payable.
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Your Student ID#
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Name of contact person at the college/university (if we have any questions).
Phone Number of contact person at the college/university (if we have any questions).
Please enter a valid phone number.
Format: (000) 000-0000.
Email address of contact person at the college university (if we have any questions).
example@example.com
THE FOLLOWING INFORMATION IS REQUIRED AND MUST BE UPLOADED TO THIS FORM.
TUITION BILL: Current and detailed copy of the college/university tuition bill that shows a current balance. Zero balance bills cannot be accepted. Bill must show awardee's name, student ID#, and college/university logo or letterhead.
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Next, download this W-9 form. Complete the form, including your SSN as well as your physical (not digital) signature. Save the form before uploading it in the following form field.
W-9 FORM: Upload your completed W-9 form with SSN included as well as your physical (not digital) signature.
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FERPA Form - Please download this form, complete it, and then save and upload it in the following form field.
FERPA Form: Upload your completed FERPA form here.
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SIGNATURE SECTION
By signing this document, I am agreeing that I have read this document and all scholarship rules and application procedures located herein. I also agree that any dispute that may arise concerning the payment of scholarships will be properly and fairly reviewed by the Arizona Volunteer Scholarship Board and their resolution shall be binding.
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Agree
Applicant's Printed Name
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First Name
Last Name
Date of Applicant Submission
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Applicant.
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Submit
Submit
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