Instructions for Recipients Requirements for receiving scholarship




Дата канвертавання18.04.2016
Памер16.45 Kb.
C-U One-to-One Mentoring Scholarship

Instructions for Recipients
Requirements for receiving scholarship:

  • Participate in the C-U One-to-One Mentoring Program for at least 3 years

  • Graduate from high school

  • Enroll in any post-secondary education (community college, trade school, technical school or University)

  • Request scholarship within two years of graduation or within two years of release from the military


Amount of scholarship:

  • $500 Semester #1; $500 Semester #2; $1000 Semester #3; $1000 Semester #4; $1000 Semester #5; $1000 Semester #6

  • $5000 total


Procedure for receiving funds:

  • Fill out the form below.

  • Send form along with confirmation of your enrollment in college (tuition or dated college bookstore receipt is acceptable) to Jeff Jacob, treasurer of the Mentoring Scholarship Foundation

  • Requests for funds must be sent before or during the semester you are in attendance (not after the fact)

  • The scholarship check will be sent within a week to your account at your college.

  • Repeat at the beginning of each subsequent semester.


Questions? Email Jeff Jacobs: jjacobs@psbank.net



Request for C-U One-to-One Scholarship Payment #1 ($500)
Name:________________________________ Graduation Date: ______________________
Current Mailing Address

Street:___________________________________

City, State:_______________________________

Zip Code:_______________________________



Telephone Number:___________________________

Email Address:_______________________________

Social Security Number_______________________________

School at which you are enrolled:_______________________________

School business office mailing address:




Mail to Jeff Jacob, Treasurer, Prairie State Bank, 1902 Fox Drive # C, Champaign, IL 61820

You must attach proof of enrollment with your request!

Request for C-U One-to-One Scholarship Payment #2 ($500)
Name:________________________________ Graduation Date: ______________________

Current Mailing Address

Street:_______________________________ City, State:____________________________

Zip Code:____________________________ Telephone Number:______________________

Email Address:_______________________________

Social Security Number_______________________________

School at which you are enrolled:_______________________________

School business office mailing address:


Mail to Jeff Jacob, Treasurer, Prairie State Bank, 1902 Fox Drive # C, Champaign, IL 61820

You must attach proof of enrollment with your request!

_________________________________________________________________________________
Request for C-U One-to-One Scholarship Payment #3 ($1000)
Name:________________________________ Graduation Date: ______________________

Current Mailing Address

Street:_______________________________ City, State:____________________________

Zip Code:____________________________ Telephone Number:______________________

Email Address:_______________________________

Social Security Number_______________________________

School at which you are enrolled:_______________________________

School business office mailing address:


Mail to Jeff Jacob, Treasurer, Prairie State Bank, 1902 Fox Drive # C, Champaign, IL 61820

You must attach proof of enrollment with your request!

_______________________________________________________________________________

Request for C-U One-to-One Scholarship Payment #4 ($1000)
Name:________________________________ Graduation Date: ______________________

Current Mailing Address

Street:_______________________________ City, State:____________________________

Zip Code:____________________________ Telephone Number:______________________

Email Address:_______________________________

Social Security Number_______________________________

School at which you are enrolled:_______________________________

School business office mailing address:


Mail to Jeff Jacob, Treasurer, Prairie State Bank, 1902 Fox Drive # C, Champaign, IL 61820

You must attach proof of enrollment with your request!
Request for C-U One-to-One Scholarship Payment #5 ($1000)
Name:________________________________ Graduation Date: ______________________

Current Mailing Address

Street:_______________________________ City, State:____________________________

Zip Code:____________________________ Telephone Number:______________________

Email Address:_______________________________

Social Security Number_______________________________

School at which you are enrolled:_______________________________

School business office mailing address:


Mail to Jeff Jacob, Treasurer, Prairie State Bank, 1902 Fox Drive # C, Champaign, IL 61820

You must attach proof of enrollment with your request!

Request for C-U One-to-One Scholarship Payment #6 ($1000)
Name:________________________________ Graduation Date: ______________________

Current Mailing Address

Street:_______________________________ City, State:____________________________

Zip Code:____________________________ Telephone Number:______________________

Email Address:_______________________________

Social Security Number_______________________________

School at which you are enrolled:_______________________________

School business office mailing address:


Mail to Jeff Jacob, Treasurer, Prairie State Bank, 1902 Fox Drive # C, Champaign, IL 61820

You must attach proof of enrollment with your request!


База данных защищена авторским правом ©shkola.of.by 2016
звярнуцца да адміністрацыі

    Галоўная старонка