The Community Foundation for Greater New Haven Universal Scholarship Remittmance Form Please submit this form by June 5, 2015 Question Title * 1. Name of Scholarship Fund Question Title * 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.orgwith the additional student information) Question Title * 3. Student No. 1 Student's First Name Student's Last Name Home Address Home Telephone Number College or University Award Amount Question Title * 4. Student No. 2 Student's First Name Student's Last Name Home Address Home Telephone Number College or University Award Amount Question Title * 5. Student No. 3 Student's First Name Student's Last Name Home Address Home Telephone Number College or University Award Amount Question Title * 6. Student No. 4 Student's First Name Student's Last Name Home Address Home Telephone Number College or University Award Amount Question Title * 7. Student No. 5 Student's First Name Student's Last Name Home Address Home Telephone Number College or University Award Amount Question Title * 8. Student No. 6 Student's First Name Student's Last Name Home Address Home Telephone Number College or University Award Amount Question Title * 9. Student No. 7 Student's First Name Student's Last Name Home Address Home Telephone Number College or University Award Amount Question Title * 10. Please describe your selection process for scholarship recipient(s). This question needs to be completed please do not answer (same as last year). Question Title * 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). Question Title * 12. Person completing this form: Name: Organization: Address: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Done