Application to Establish Scholarship

Byron-Bergen Central School District

Name of person submitting application: 		_______________________________________ 
Address:  						_______________________________________
Phone:  						_______________________________________ 
Email:							_______________________________________		

Name of Scholarship for Approval:  		________________________________________

Will this scholarship be awarded for only this school year or multiple years:  	________________________ 
Will this scholarship be awarded to one or more seniors:  			________________________
		
Amount of Scholarship:		________________________________________

Funds provided by: 			________________________________________ 

Reason for creating this scholarship:    	_____________________________________________________ 

_________________________________________________________________________________________ 

_________________________________________________________________________________________ 

What specific criteria will be required when considering an appropriate candidate:  _________________ 

_________________________________________________________________________________________ 

_________________________________________________________________________________________ 

Do you have a preference as to when you would like this scholarship awarded?  At Graduation, Academic Awards Night, Athletic Awards Night or An Afternoon of Music?  _______________________ 

_________________________________________________________________________________________ 

Upon approval, you will be contacted for further specifics of this award.

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Required approval:

Superintendent:    ___________________________  	Date:  __________    

Jr./Sr. High Principal:   _______________________  	Date:  __________
 
Business Official:  ___________________________  	Date:  __________

Board of Education:  _________________________  	Date:  __________

Completed copies will also be forward to the Counseling Office, Jr./Sr. High Principal, Jr./Sr. High Office