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MISSISSIPPI VALLEY STATE UNIVERSITY (Mississippi Delta Community College)

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MISSISSIPPI VALLEY STATE UNIVERSITY
FACULTY/STAFF
RECIPROCAL SCHOLARSHIP FORM
MDCC Applicant:
MVSU ID #
(do not use social security #)
Semester and Year Applying For:
Course Number, Description, and Hours (6 hours maximum) Applying For:
Employee Date
Appropriate Supervisor Date
Associate Vice President / Vice President Date
President Date
After all signatures have been obtained, the President’s office will forward this form to Human Resources. HR will then email a
copy of the approved form to employee. Employee will then be responsible in taking form to MVSU.
Updated 01/08/2019
Mississippi Delta Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities.
The following person has been designated to handle inquiries regarding the non-discrimination policies: The Associate VP for Institutional Effectiveness,
Boggs-Scroggins Student Services Center, P.O. Box 668, Moorhead, MS 38761, 662-246-6558.
(Schedule must be attached)
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MISSISSIPPI VALLEY STATE UNIVERSITY (Mississippi Delta Community College)

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Completed 19 September 2020

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