Development Foundation Guidelines for Scholarships

Poplarville, MS 39470.

Contact: Webmaster

Last Update 6-18-2007.

Scholarship Guidelines/Development Foundation

This form generates a pdf file. In order to open it, you will need a pdf reader like Adobe Reader. It can be dowloaded for free from Adobe's website.

A blank pdf of this form can be downloaded from this link if you would rather print out a copy and mail it to the Development Foundation.

* Indicates a required field.

Donor Identification

First Name:

Middle name:

Last name:

E-mail Address:

Phone Number (Day): - Phone Number (Day): - Phone Number (Day):

Phone Number (Night): - Phone Number (Night): - Phone Number (Night):

Address:

City/Town:

State:

Zip Code:

Funding Details

Funding Options: Full Endowment (min. $20,000) Partial Endowment Annual Gift

Funding Amount:

Donor Explanation of Funding:

Scholarship Details

Title of Scholarship (Determined by Donor):

Annual Amount Awarded:

Method of Payment: Beginning of Fall Beginning of Spring Equal Split for Fall and Spring

Mechanics of Scholarship

Criteria: (EX: full time student, financial need, GPA, major, geographic location)

Retaining Conditions: (EX: Must maintain minimum 2.0 GPA)

Additional Notes:

Any remaining balance after fees are paid are to be:

Disbursed to student Returned to Donor's Fund

Modifications The Development Foundation at Pearl River Community College allows the donor the right to modify this scholarship/program guidelines, but in the event of such modification, the Pearl River Community College Development Foundation must be notified at least three months prior to the beginning of the next school year.

I have read and agree with the policy.

Donor Verfication To be completed by donor as acceptance of the guidelines.

Initials:

Date of Birth: Date of Birth: Year of Birth:

Press the ''Submit Application'' button to transfer this information to Pearl River Community College, Development Foundation. If for some reason you do not receive an email (if you provided one) acknowledging our receipt of your application within 72 hours, you should resubmit your application, use the printable version of the application, or call 601-403-1183 and request that an application be sent to you by U. S. mail.

Pearl River Community College offers equal education and employment opportunities. We do not discriminate on the basis of race, religion, color, sex, age, national origin, veteran status, or disability. For inquiries regarding the non-discrimination policies or to request accommodations, special assistance, or alternate format publication please contact Tonia Moody, ADA/Civil Rights Coordinator, at P.O. Box 5118, Poplarville, MS, 39470 or 601-403-1060.

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