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Instructions: You have six (6) months from the date you received this form to return it. Please be sure that you are actively enrolled in classes before you complete and return this form. We will not engage in independent investigation to determine where or how to send your scholarship funds to ensure timely processing and application to your account. Do your research with your school to ensure you are providing correct information and instructions prior to submitting this form. Failure to do so could result in the forfeiture of your prize.

Contact Information of Scholarship Recipient:


College or University Information

EXACT address to which external scholarship funds must be sent- Please include receiving department (ie. Financial Aid, Scholarships, Cashier, etc.)*
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