Fillable Matching Scholarship Program Form - Matching Scholarship Program Form

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Matching Scholarship Program Form - Matching Scholarship Program Form

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U.S.A. forms for California State University, Fresno

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Chapter and Club
Matching Scholarship Program Form
!
Fresno State Alumni Association | www.fresnostatealumni.com | Phone: 559.278.ALUM | Fax: 559.278.6790
Chapter or Club Name:
____________________________________________________________
Instructions:
1. This form must be submitted by no later than June 30
th
of each year, for the next fiscal year.
2. Matching funds are limited. Preference will be given to those chapters/clubs who submit their request first.
3. Matched dollars are only provided for scholarship endowment earnings, not on funds in the chapter/club
operating account.
4. Signatures must be original signatures (may not be a digital or type-written signature).
5. The preparer may not be the approved signer.
6. The approved signer must be an “Authorized Signer” on the chapter/club account.
7. Note: Scholarship recipient names and student ID numbers will be verified for:
a. Enrollment in the next academic year.
b. For completed, submitted and approved online scholarship application.
8. Submit the completed form to Peter Robertson (probertson@csufresno.edu) via email (scanned
document), or fax (see footer of this page for fax number).
Name of scholarship:
________________________________________________________________________
Amount you are requesting to be matched (maximum of $500):
$__________________
Contact person:
Title:
Cell phone:
Email:
!
!
ACCOUNT SIGNER AUTHORIZATION
Prepared by (print name):
___________________________________________
Date:
__________________
Approved signer:
Print name:
___________________________________________________________
Signature:
________________________________
Date:
__________________
!
!
FSAA OFFICE STAFF USE ONLY
Chapter/Club…
…is in good standing.
Initials:_________
Date: _________
…complies with maintenance requirements.
Initials:_________
Date: _________
…has monies in scholarship endowment account.
Initials:_________
Date: _________
Operating account balance:
$__________________
Initials:_________
Date: _________
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Matching Scholarship Program Form - Matching Scholarship Program Form

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Completed 3 May 2020

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