Foundation Scholarship Establishment Form

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: * Required
Street Address City State ZIP Code
Phone: * Required
Email: * Required
Does donor wish to remain anonymous? * Required
- Yes
- No
Scholarship Information
Scholarship Name * Required
Number of recipients per year: * Required
Please enter a number from 1 to 100.
Scholarship will be provided: * Required
- Annually
- One Time Only
- Other
Scholarship awarded to recipient for: * Required
- One Year
- Two Years
Please specify for "other" scholarship provision: * Required
Scholarship to be applied to: * Required
- Tuition & Fees, Only
- Educational related expense
Can monies be refunded to the student if all expenses are paid? * Required
- Yes
- No
Scholarship may be used: * Required
- Fall
- Winter
- Spring/Summer
Minimum Annual Gift Amount: * Required
Amounts will populate on contract signature page upon submission.
Total Gift Amount: * Required
(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: * Required
- 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: * Required
- 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:
Degree Programs
Scholarships can be applied to multiple programs.
- Associate of Applied Science in Agricultural Equipment Technology
- Associate of Applied Science in Agricultural Operations – MSU Concentration
- Associate of Applied Science in Allied Health
- Associate of Applied Science in Business
- Associate of Applied Science in Criminal Justice
- Associate of Applied Science in Nursing
- Associate of Applied Science in Technology
- Associate of Arts
- Associate of Business
- Associate of General Studies
- Associate of Science
Certificate Program
Scholarships can be applied to multiple programs.
- Accounting Certificate
- Machine Tool Technology Certificate
- Agricultural Equipment Technology Certificate
- Management/Marketing Certificate
- Automotive Technician Certificate
- Management/Supervision Certificate
- Automotive Service Certificate
- Medical Administrative Specialist Certificate
- Computer Support Technician Certificate
- Medical Assistant Certificate
- Coding Specialists/Physician Based
- Phlebotomy Technician
- Electrical Technologies
- Practical Nursing Certificate
- Health Care Worker
SELECTION CRITERIA (check those you wish to be used)
Minimum Grade Point Average * Required
(select below)
- 4.0 = A
- 3.5 = A/B
- 3.0 = B
- 2.5 = B/C
- 2.0 = C
St. Joseph County Resident
- Yes
- No
- Other
Financial Need Consideration
- Yes
- No
Please specify "other" residency:
Additional Comments:
Name
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)