( ) General Fund ( ) Scholarship ( ) Endowed
Scholarship Title:
_________________________________________________
Donor Name:
_________________________________________________
I. Terms of Gift Donation:
• Total Gift Donation: _____________
• Date(s) of Gift Donation: _____________
• Gift Donation Payment(s):
( ) One Time Gift
( ) Ongoing Term
( ) Weekly
( ) Monthly
( ) Quarterly
( ) Annually
• Donor wishes to remain anonymous: _____ Yes _____ No
• Donor Biography provided to Scholarship Recipient(s): _____ Yes _____ No
If yes, biography provided
II. Scholarship Specific:
• Scholarship available for school year: ____________
• Award half each semester: _____ Yes _____ No
• College Specific: _____ Yes _____ No
If yes, College of Preference: __________________
• Financial Need: _____ Primary _____ Secondary
• Underrepresented: _____ Yes _____ No
If yes, specific: __________________
• Cumulative GPA on a 4.0 grade scale:
____ 3.5 or Higher; ____ 3.25 or Higher; ____ 3.0 or Higher; ____ 2.5 or Higher
• Check one or more of the following:
___ High School Senior;
___ College Freshman; ___ College Sophomore; ___ College Junior; ___ College Senior
• Authorization to work in United States: _____ Yes _____ No
• Major Specific:
___ Pilot; ___ Air Traffic Control; ___ Aeronautical Engineer; ___ Aviation Business & Management; ___ Airframe & Powerplant Mechanic - Aviation Electronics Technician
III. Contact Person:
Name: _______________________________
Address: _______________________________ _______________________________
City, State: ___________, ________ Zip Code: ___________
Email: ________________________________
Phone: _________________ Fax: _________________
Donor Signature: _______________________________ Date: _______________
Questions?
Judith A. Rice, Careers in Aviation, President/CEO
386-586-6574 (Direct) or email: