The Valley Community Foundation Survey

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1. Name of Scholarship Fund

Name of Scholarship Fund

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2. Grant Number (You can find this number in the report next to the fund name)

Grant Number (You can find this number in the report next to the fund name)

Please complete the following for each scholarship recipient.
SCROLL to Question 10 to complete the form after your students have been entered.
(If you have more than 7 scholarship recipients, email Deb Wright at dwright@cfgnh.org
with the additional student information)

3. Student No. 1

Student No. 1 Student's First Name
Student's Last Name
Home Address
Home Telephone Number
College or University
Award Amount

4. Student No. 2

Student No. 2 Student's First Name
Student's Last Name
Home Address
Home Telephone Number
College or University
Award Amount

5. Student No. 3

Student No. 3 Student's First Name
Student's Last Name
Home Address
Home Telephone Number
College or University
Award Amount

6. Student No. 4

Student No. 4 Student's First Name
Student's Last Name
Home Address
Home Telephone Number
College or University
Award Amount

7. Student No. 5

Student No. 5 Student's First Name
Student's Last Name
Home Address
Home Telephone Number
College or University
Award Amount

8. Student No. 6

Student No. 6 Student's First Name
Student's Last Name
Home Address
Home Telephone Number
College or University
Award Amount

9. Student No. 7

Student No. 7 Student's First Name
Student's Last Name
Home Address
Home Telephone Number
College or University
Award Amount

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10. Please describe your selection process for scholarship recipient(s), IF SELECTION PROCESS IS SAME AS SUBMITTED LAST YEAR PLEASE WRITE 'SAME'. IF YOU DID NOT SUBMIT THIS FORM LAST YEAR PLEASE COMPLETE THIS SECTION::

Please describe your selection process for scholarship recipient(s), IF SELECTION PROCESS IS SAME AS SUBMITTED LAST YEAR PLEASE WRITE 'SAME'. IF YOU DID NOT SUBMIT THIS FORM LAST YEAR PLEASE COMPLETE THIS SECTION::

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11. In the space below, please list your committee members with titles, IF COMMITTEE MEMBERS ARE THE SAME AS SUBMITTED LAST YEAR PLEASE WRITE 'SAME'. IF YOU DID NOT SUBMIT THIS FORM LAST YEAR PLEASE COMPLETE THIS SECTION::

In the space below, please list your committee members with titles, IF COMMITTEE MEMBERS ARE THE SAME AS SUBMITTED LAST YEAR PLEASE WRITE 'SAME'. IF YOU DID NOT SUBMIT THIS FORM LAST YEAR PLEASE COMPLETE THIS SECTION::

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12. Person completing this form:

Person completing this form: Name:
Organization:
Address:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

The Valley Community Foundation

Universal Scholarship Remittmance Form

*1. Name of Scholarship Fund

*2. Grant Number (You can find this number in the report next to the fund name)