Universal Scholarship Remittmance Form

Please submit this form by June 5, 2015

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* 1. Name of Scholarship Fund

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* 2. Grant Number (You can find this number on 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)

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* 3. Student No. 1

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* 4. Student No. 2

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* 5. Student No. 3

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* 6. Student No. 4

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* 7. Student No. 5

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* 8. Student No. 6

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* 9. Student No. 7

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* 10. Please describe your selection process for scholarship recipient(s). This question needs to be completed please do not answer (same as last year).

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* 11. In the space below, please list your committee members with titles. This question needs to be completed please do not answer (same as last year).

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* 12. Person completing this form:

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