Claim Your ECMC College Nights Scholarship

Please complete the following questions to claim your ECMC College Nights scholarship award.

Questions? Email collegenights@ecmc.org.

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* 1. First name

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* 2. Last name

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* 3. Phone number

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* 4. Email address

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* 5. Parent/guardian email address

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* 6. High school where you won your award

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* 7. College name

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* 8. College address where scholarship check should be sent (If you are unsure, check your college's website and/or contact the Financial Aid Office.)

Attention To

College Street Address

College Street Address 2

College City

College State

College Zip Code

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* 9. College student ID number

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* 10. Which academic year are you requesting a disbursement for?

2023-2024

2024-2025

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* 11. Which term are you requesting a disbursement for?

Fall

Winter

Spring

Summer

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* 12. Upload evidence of enrollment for the term that you want the scholarship funds to be applied. The document must include your first and last name, college name and term preprinted on it. Examples include:

Copy of your class schedule

Copy of your tuition bill

Enrollment verification form from your college

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.