PCEF SCHOLARSHIP DISBURSEMENT FORM

PCEF SCHOLARSHIP DISBURSEMENT FORM

Visit the PCEF website for instructions
First Name
Last Name
Middle Initial
Student College ID
Street Address
City
State
Zip code
Phone Number
Birthdate

MonthDayYear
Date
Email Address (NOT high school email)
example@example.com
Name of College/University/Technical School you will be attending
The approximate date you will start

MonthDayYear
Date
Anticipated Graduation Date

MonthDayYear
Date
Street address of Financial Office (where to send scholarship award)
City
State
Zip code
Name of Scholarship Awarded
Year Awarded
Scholarship Award Amount
Disbursement Request Amount
Office Use – Check # and Date Sent
Use of Funds: (see scholarship award payment guidelines)

TuitionBooksComputer Equipment/CalculatorsOther Items (approval required)
Explanation of items:
A copy of your proof of enrollment, tuition bill, or receipt for items purchased must be included. Without proof of enrollment AND this form, PCEF cannot send any funds to the college/university/technical school.

You can upload your tution bill / proof of enrollment online using the following form:

https://form.jotform.com/PCEF_Roxboro/proof-of-enrollment

Please make sure that you have included your COLLEGE ID NUMBER!
Should be Empty: