Terms of Scholarship

THIS FORM IS INTENDED TO BE USED BY STUDENTS WHO HAVE ALREADY BEEN AWARDED AN ECMC SCHOLARS PROGRAM SCHOLARSHIP.
ATTENTION STUDENTS: Please do not complete this scholarship disbursement request until you are registered for classes at your postsecondary institution of choice. This request requires a copy of your current financial aid award letter and class schedule. This request must be submitted for each semester or quarter you are seeking a scholarship disbursement for.

You must enroll in a postsecondary institution within six (6) months of high school graduation and be enrolled in a degree or certificate program at a college, university, or career and technical education center that is accredited by a federally-recognized accrediting agency. To learn more about accreditation, please visit: https://ope.ed.gov/accreditation/.

You must use your full $6,000.00 scholarship within six years of high school graduation.
 
PLEASE NOTE: You are eligible to use your ECMC Scholars Program scholarship, even if you are eligible to receive other forms of financial aid. The ECMC Scholars Program scholarship is based on NET PRICE (cost of attendance - gift aid). Once your direct costs are paid to the institution, the institution is eligible to disburse the balance to you to assist in covering your educationally-related indirect costs. Examples of indirect costs may include: housing, food, transportation, school supplies, etc. 

If you have any questions, or need additional information, regarding the ECMC Scholars Program please contact us at studentsuccess@ecmc.org.

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* 1. Date

Date / Time

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* 2. Institution Student ID Number

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* 3. First Name

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* 4. Middle Name

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* 5. Last Name

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* 6. Street Address

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* 7. City

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* 8. State

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* 9. Zip

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* 10. Email Address

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* 11. Cell Phone Number

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* 12. Date of Birth

Date / Time

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* 13. Academic Year

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* 14. What Is Your Current Student Classification (or Class Standing) With Your Institution?

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* 15. What Term Are You Requesting Disbursement For?

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* 16. Enrollment Status

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* 17. Degree Type

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* 18. Institution Type

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* 19. Federal School Code

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* 20. Term Type

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* 21. Anticipated Institution Graduation Date

Date / Time

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* 22. Institution Name

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* 23. Institution Mailing Address

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* 24. Institution City

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* 25. Institution State

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* 26. Institution Zip

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* 27. Requested Award Amount
If you have a special request for an amount different than what is listed below, please pick one of the options below and immediately email sberg@ecmc.org with the amount you would like paid out instead.

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* 28. Upload Financial Aid Award Letter For The Term You Are Requesting a Disbursement Be Made For

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen

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* 29. Upload Class Schedule For The Term You Are Requesting A Disbursement Be Made For

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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No file chosen

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* 30. Student Acknowledgement

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I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief.
I affirm that it may take up to 30 days from the date of submission to process my scholarship disbursement.
I affirm that documentation must be provided for each semester or quarter I am requesting a disbursement for.
I affirm that I enrolled in postsecondary education within six months of graduation from high school. 

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