Scholarship Request for Student Loans
Completion of this form and the attachments of the necessary documentation is required for the payment of all scholarships. Please allow up to 30 days from the receipt of all required documentation for payment to be processed, paid, and sent to you. Once you receive your scholarship check, it is your responsibility to deliver it to your lending institution. Every effort will be made to process each request in a timely manner. Failure to provide all required information on this form along with attachments will cause delays in processing your scholarship application.
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).
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Date of Birth
*
-
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.
*
-
Month
-
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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EDUCATIONAL LOAN COMPANY INFORMATION
Name of loan company to which the check should be payable.
*
Name of contact person at the loan company (if we have any questions).
Phone Number of contact person at the loan company (if we have any questions).
Please enter a valid phone number.
Format: (000) 000-0000.
Email address of contact person at the loan company (if we have any questions).
example@example.com
Loan Company Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Loan account number:
*
Current loan balance:
*
Is the loan in your name as primary?
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Yes
No
If you are not the primary listed on the loan, please list the name(s) on the loan and their relationship to you.
Are you listed as secondary on the loan?
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Yes
No
Would you prefer one check made out to the loan company for the total amount of your scholarship, or would you prefer multiple checks to apply to your loan payment over several months?
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One check
Multiple checks
Type option 3
Type option 4
If you selected "Multiple checks", please provide detailed instructions, such as "please split the total amount into 6 checks." Describe below:
THE FOLLOWING INFORMATION IS REQUIRED AND MUST BE UPLOADED TO THIS FORM.
UPLOAD a copy of your outstanding student loan document with the loan balance. Loan must indicate the awardee as the primary or secondary on the loan agreement.
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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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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
*
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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