Scholarship Disbursement Request

Student Information

Scholarship Claim Form
Your Name: *

First Name Last Name
Email Address: *
Email
Phone Number: *

Area Code Phone Number
Name of the ISF Scholarship Awarded:
Would you like to claim part of your scholarship now or defer scholarship disbursement for a later time? *

Claim Now Defer for Later (no amount will be sent out)

College/University Information

Scholarship Claim Form
College/University Name: *
College/University Financial Aid Mailing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
College/University Student ID: *
What semester are you requesting a disbursement for? *
How many hours are you enrolled in for the semester you are requesting a disbursement? *
How much are you requesting to be disbursed? *
Please put dollar amount to be sent to your school not exceeding your bill balance.
Are you a Joy and Ralph Ellis Scholarship Recipient? *

Yes No
Where would you like your disbursement sent?

Directly to my university provided above. To me please.
Please provide your mailing address as your check will be made out to you for deposit.

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How much are you requesting to be disbursed? *

Required Documentation

Scholarship Claim Form
Current school bill with a balance. *
We cannot pay from a $0 due invoice or negative balance.
Schedule showing course hour credit for the semester requesting funds for. *

Browse Files

Cancel of
Is this your first semester of college? *

Yes No
Click to upload unofficial transcript showing cumulative GPA. *

Upload a File
Max Total Upload Size: 500MB Cancel of
Additional Items:

Browse Files
Not required Cancel of

Defer Disbursement

Scholarship Claim Form
What semester are you requesting a deferment for? *
Please explain why you would like to defer your scholarship disbursement for approval. *
Please Notes: A deferment request must be completed at the beginning of each semester to continue to hold your scholarship.

Student Information