Foundation Scholarship Establishment – Glen Oaks Community College

This fund is established to recognize a scholastic achievement, to encourage continued progress, and to provide assistance to students in financing their education at Glen Oaks Community College, and is to be administered according to the following provisions:

Donor Information

Donor's Name:

First Middle Last

Address: *

Street Address City State ZIP Code

Phone: *

Email: *

Does donor wish to remain anonymous? *

Yes
No

Scholarship Information

Scholarship Name *

Number of recipients per year: *

Please enter a number from 1 to 100.

Scholarship will be provided: *

Annually
One Time Only
Other

Scholarship awarded to recipient for: *

One Year
Two Years

Please specify for "other" scholarship provision: *

Scholarship to be applied to: *

Tuition & Fees, Only
Educational related expense

Can monies be refunded to the student if all expenses are paid? *

Yes
No

Scholarship may be used: *

Fall
Winter
Spring/Summer

Minimum Annual Gift Amount: *

Amounts will populate on contract signature page upon submission.

Total Gift Amount: *

(see example below)

*Example:

It is the present intention of the donor to make a minimum annual gift of (*Minimum Annual Gift Amount), on or before June 30th, in order to award this scholarship in the upcoming academic year; or a total gift of (*Total Gift Amount). To establish an endowed fund the minimum dollar amount is $10,000, to be accumulated within a five-year period. The monies will be held in a restricted endowment account until the balance reaches the minimum amount required by the Foundation Policy. Funds will be held for 2 years for income growth before distribution is made.

ELIGIBILITY (check those you wish to be used)

Student Status: *

Full-time (12 credits or more)
at least ¾ time (11 – 9 credit hours)
at least ½ time (8 – 6 credit hours)
Less than half-time

Grade Level: *

1st year student
2nd year student
no preference

What type of program would you like this scholarship to be applied:

Degree Program
Certificate Program
Wherever funds may be needed

Please indicate which Degree Program you would like this scholarship to apply:

Please indicate which Certificate Program you would like this scholarship to apply:

SELECTION CRITERIA (check those you wish to be used)

St. Joseph County Resident

Yes
No
Other

Financial Need Consideration

Yes
No

Please specify "other" residency:

Additional Comments:

Phone

This field is for validation purposes and should be left unchanged.

Foundation Scholarship Establishment Form

Donor Information

Scholarship Information

ELIGIBILITY (check those you wish to be used)

SELECTION CRITERIA (check those you wish to be used)