2012 Scholarship Data Sheet
Scholarships awards will not be disbursed until this Data Sheet is returned.
All information provided will be considered confidential.
Full Name: ___________________________________________________________________
(first) (middle) (last)
School Name _________________________________________________________________
Personal School Address: _______________________________________________________
Email Address You Check Regularly: ___________________________________
SOCIAL SECURITY NUMBER: ______________________________________________
STUDENT IDENTIFICATION NUMBER: _______________________________________
FINANCIAL AID OFFICE: Contact them and ask to whom we should fax or email the
Name of Contact: _____________________________________________________________
Phone Number: _____________________________________________________________
Fax Number: _____________________________ Email : _________________________
Please include a picture of yourself with the data sheet.
Once we receive your data sheet:
1. We will send the agreement to the contact person you indicate above.
2. We will fax them an agreement stating your scholarship may be used for tuition, books and fees
only. According to IRS laws, this agreement must be signed by the school before we can send
them your scholarship award. (IRS Code 501 c 3)
3. Once we receive a signed agreement, your scholarship award will be mailed to the school.
4. We will notify you when we mail it so you can watch your student account for credit.
If we do not receive a signed agreement from your school, it is your responsibility to contact them and
insure this is done so you can receive your award.
FOR OFFICE USE ONLY
Return this Data Sheet to: Questions: Contact School
II-VI Foundation 412-206-0580
1370 Washington Pike firstname.lastname@example.org
Suite 404 Agreement Faxed
Bridgeville, PA 15017
Signed Agreement Received