Miss Illinois Local/State Scholarship Retrieval

Miss Illinois Local/State Scholarship Retrieval
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Birthday*

MonthDayYear
Date
Last 4 Digits of Social Security Number*
High School Name/City*
High School Graduation Year*
College Name*
College Major*
Local Title*
Miss Illinois Competition Year*
I am submitting for a*
Local Amount Requested (write N/A if only claiming State) (Your Local Director must confirm in writing this has been paid before State money is requested)*
State Amount Requested (write N/A if only claiming Local)*
Email*
example@example.com
Please attach the appropriate supporting documents.

For current educational expenses: Part or all of your scholarship may be applied towards tuition/room and board.

Items required to process:
- Current detailed tuition statement from university (no later than 30 days) w/school ID # & remittance address - MUST HAVE IDENTIFYING INFORMATION ON THE BILL SUCH AS NAME OR STUDENT ID #
  IF YOUR STATEMENT SAYS YOU ARE PAID IN FULL, THEN YOU WILL HAVE NOTHING TO CLAIM! PLEASE SUBMIT YOUR RETRIEVAL REQUEST BEFORE YOU PAY ANYTHING OUT OF POCKET.
- Room and board requests require a tuition statement reflecting full-time status of 12 credit hours.
- Official or Unofficial Transcript
Please attach the appropriate aforementioned attachments for your scholarship payments. Your scholarship will not be processed without the proper attachments and you will be asked to resubmit the entire form.
Supporting Document 1 - Tuition Statement*

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Supporting Document 2 - Class list showing 12 hours enrollment*

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Supporting Document 3*

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Supporting Document 4

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Supporting Document 5

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Student ID*
Student Name*
College/University Mailing Address*