Scholarship Reporting (school/institution use only)

Organization Name:*
Scholarship Fund Name:*
Grant Amount:*
Grant Date:*
Grant Number:
Contact Person:*
Contact Email:*
Name of scholarship recipient(s), including amount awarded, declared major and school email address for each student:*
Date scholarship funds were disbursed to student account(s):*
Were all of the grant funds disbursed?*
- Yes
- No
I certify that the selection of the recipient was done in an open, fair and equitable process; that no member of any recipient's immediate family participated in the selection process; and that the criteria for the scholarship, as determined by the donor, was fully met.*
- Yes
- No
Signature:*

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.